Freeform by Equip, A Virtual Body Empowerment Program

  • Thank you for your interest in Equip Freeform!

    Please fill out the following survey to begin signing up for an upcoming Freeform body image group. If you have any questions, please email freeform@equip.health.

  • Format: (000) 000-0000.

    • Consent to Record 

    • Consent to Record

      Previous research has actually shown a higher impact of the group when the sessions were recorded and we also want to continually adapt and improve the program. We currently record all Freeform groups.

      If you are under 18, please have a parent or guardian complete the following section. (18+ can complete this section on their own)

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    • Do you consent to record the Freeform Group?*
    • Survey Questions -- SATAQ-4 
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    • EDEQS 
    • Over the past 28 days, how many days did you deliberately try to limit the amount of food you ate in order to influence your shape or weight?
    • Over the past 28 days, how many days did you try to exclude foods that you like from your diet in order to influence your shape or weight?
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    • During the past 3 months, have there been times when you have eaten what other people would regard as an unusually large amount of food (e.g., a pint of ice cream) given the circumstances?*
  • During the times when you at an unusually large amount of food, did you experience a loss of control (e.g., felt you couldn't stop eating or control what or how much you were eating)?*
  • How many times per month on average over the past 3 months have you eaten an unusually large amount of food and experienced a loss of control?
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  • How many times per month on average over the past 3 months have you eaten after awakening from sleep or eaten an unusually large amount of food after your evening meal and felt distressed by the night eating?
  • How much does any eating or body image problem impact your relationship with friends and family, work performance, and/or school performance?

  • After pressing submit, you will be automatically redirected to our Freeform Acuity Scheduling page to pick the specific group you would like to sign-up for.

    Please email freeform@equip.health if you have an questions! 

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