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Binge Eating Scale
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Use our readymade template to create your Binge Eating Scale (BES) assessment tool for diagnosing and assessing the severity of binge eating disorder

Create your care assessments

BES score Binge Eating Problem Proposed treatment
0-17 Minimal May not need treatment
18-26 Moderate Consider counseling
27-48 Severe Active treatment
  • navigate_next Prebuilt template with BES scoring to assess the presence of binge eating disorder and measure its severity
  • navigate_next 16-item questionnaire that scores each item from “0” to “3” based on the severity of the behavior
  • navigate_next Real-time calculation of BES Score and binge eating problem based on the form responses
  • navigate_next Collect patient data and other sensitive healthcare data using our HIPAA compliant online assessment forms
  • navigate_next Compare the scores from the initial screening with that of the followup to track the progression of the disorder
  • navigate_next Easily create responsive forms that allow patients to complete their assessments on any device at any time

Collect responses from your patients

Patient ID 1004
Patient Name John W
Patient Email johnw@ymail.com
Patient Phone Number 0987654321
Doctor's Name Dr. Smith
Location New York
1. I frequently think about my weight and feel great shame and disgust.
2. Usually I swallow my food almost without chewing, then feel as if I ate too much.
3. Because I feel so helpless about controlling my eating I have become very desperate about trying to get in control.
4. I have a strong habit of eating when I’m bored. Nothing seems to help me break the habit.
5. Although I’m not physically hungry, I get a hungry feeling in my mouth that only seems to be satisfied when I eat a food, like a sandwich, that fills my mouth. Sometimes, when I eat the food to satisfy my mouth hunger, I then spit the food out so I won’t gain weight.
6. Almost all the time I experience strong guilt or self-hate after I overeat.
7. I have a regular habit of starting strict diets for myself, but I break the diets by going on an eating binge. My life seems to be either a “feast” or “famine.”
8. I eat so much food that I regularly feel quite uncomfortable after eating and sometimes a bit nauseous.
9. In my adult years, I have had week-long periods where I practically starve myself. This follows periods when I overeat. It seems I live a life of either “feast or famine.”
10. I feel incapable of controlling urges to eat. I have a fear of not being able to stop eating voluntarily.
11. Because I have a problem not being able to stop eating when I want, I sometimes have to induce vomiting to relieve my stuffed feeling.
12. I feel so ashamed about overeating that I pick times to overeat when I know no one will see me. I feel like a “closet eater.”
13. There are regular periods when I seem to be continually eating, with no planned meals.
14. It seems to me that most of my waking hours are pre-occupied by thoughts about eating or not eating. I feel like I’m constantly struggling not to eat.
15. Most of my days seem to be pre-occupied with thoughts about food. I feel like I live to eat.
16. Even though I might know how many calories I should eat, I don’t have any idea what is a “normal” amount of food for me.
BES Score 45
Binge Eating Problem Severe
  • navigate_next Pre-populate patient details such as patient id, name, email etc in the BES assessment form before sharing it with the patients
  • navigate_next Send an email invitation with a secure link for patients to complete their BES assessment form prior to their visit
  • navigate_next Allow patients to save their progress and complete their BES assessment form at a later time without losing any responses
  • navigate_next Set up an email template for your BES assessment and automatically send invitation emails to multiple patients with ease
  • navigate_next Send a confirmation email to the patients with their BES score, diagnosis, next steps when they submit their BES assessment

Track patient responses in Google Sheets

A B C D E
1 Name Question Answer Score Total Score
2 John W 1. I frequently think about my weight and feel great shame and disgust. 3 45
3 John W 2. Usually I swallow my food almost without chewing, then feel as if I ate too much. 3 45
4 John W 3. Because I feel so helpless about controlling my eating I have become very desperate about trying to get in control. 3 45
5 John W 4. I have a strong habit of eating when I’m bored. Nothing seems to help me break the habit. 3 45
6 John W 5. Although I’m not physically hungry, I get a hungry feeling in my mouth that only seems to be satisfied when I eat a food, like a sandwich, that fills my mouth. Sometimes, when I eat the food to satisfy my mouth hunger, I then spit the food out so I won’t gain weight. 3 45
7 John W 6. Almost all the time I experience strong guilt or self-hate after I overeat. 2 45
8 John W 7. I have a regular habit of starting strict diets for myself, but I break the diets by going on an eating binge. My life seems to be either a “feast” or “famine.” 3 45
9 John W 8. I eat so much food that I regularly feel quite uncomfortable after eating and sometimes a bit nauseous. 3 45
10 John W 9. In my adult years, I have had week-long periods where I practically starve myself. This follows periods when I overeat. It seems I live a life of either “feast or famine.” 3 45
11 John W 10. I feel incapable of controlling urges to eat. I have a fear of not being able to stop eating voluntarily. 3 45
12 John W 11. Because I have a problem not being able to stop eating when I want, I sometimes have to induce vomiting to relieve my stuffed feeling. 3 45
13 John W 12. I feel so ashamed about overeating that I pick times to overeat when I know no one will see me. I feel like a “closet eater.” 3 45
14 John W 13. There are regular periods when I seem to be continually eating, with no planned meals. 3 45
15 John W 14. It seems to me that most of my waking hours are pre-occupied by thoughts about eating or not eating. I feel like I’m constantly struggling not to eat. 3 45
16 John W 15. Most of my days seem to be pre-occupied with thoughts about food. I feel like I live to eat. 3 45
17 John W 16. Even though I might know how many calories I should eat, I don’t have any idea what is a “normal” amount of food for me. 2 45
  • navigate_next Export patient responses including the calculated BES score and binge eating problem to Google Sheets for easy record-keeping
  • navigate_next Export individual points for each item to Google Sheets for data manipulation and analysis for comprehensive insights
  • navigate_next Use pre-built reports to easily keep track of patient progress over time and monitor changes in their eating behaviors
  • navigate_next Receive a copy of the response and the calculated BES score by email whenever a patient submits their BES assessment
  • navigate_next Use data in Google Sheets to integrate with external EHR systems for seamless data transfer

HIPAA compliance

Patient ID: 1004
Patient Name: ******
Patient Email: ******
Patient Phone Number: ******
Doctor's Name: Dr. Smith
Location: New York
1.: I frequently think about my weight and feel great shame and disgust.
2.: Usually I swallow my food almost without chewing, then feel as if I ate too much.
3.: Because I feel so helpless about controlling my eating I have become very desperate about trying to get in control.
4.: I have a strong habit of eating when I’m bored. Nothing seems to help me break the habit.
5.: Although I’m not physically hungry, I get a hungry feeling in my mouth that only seems to be satisfied when I eat a food, like a sandwich, that fills my mouth. Sometimes, when I eat the food to satisfy my mouth hunger, I then spit the food out so I won’t gain weight.
6.: Almost all the time I experience strong guilt or self-hate after I overeat.
7.: I have a regular habit of starting strict diets for myself, but I break the diets by going on an eating binge. My life seems to be either a “feast” or “famine.”
8.: I eat so much food that I regularly feel quite uncomfortable after eating and sometimes a bit nauseous.
9.: In my adult years, I have had week-long periods where I practically starve myself. This follows periods when I overeat. It seems I live a life of either “feast or famine.”
10.: I feel incapable of controlling urges to eat. I have a fear of not being able to stop eating voluntarily.
11.: Because I have a problem not being able to stop eating when I want, I sometimes have to induce vomiting to relieve my stuffed feeling.
12.: I feel so ashamed about overeating that I pick times to overeat when I know no one will see me. I feel like a “closet eater.”
13.: There are regular periods when I seem to be continually eating, with no planned meals.
14.: It seems to me that most of my waking hours are pre-occupied by thoughts about eating or not eating. I feel like I’m constantly struggling not to eat.
15.: Most of my days seem to be pre-occupied with thoughts about food. I feel like I live to eat.
16.: Even though I might know how many calories I should eat, I don’t have any idea what is a “normal” amount of food for me.
BES Score: 45
Binge Eating Problem: Severe
BES Score: 45
Binge Eating Problem: Severe
  • navigate_next Create a HIPAA compliant BES assessment form to safely collect, store and access patient responses
  • navigate_next Mark fields as Protected Health Information (PHI) to secure sensitive patient data and limit access to PHI
  • navigate_next Automatically mask PHI fields when exporting BES form responses to Google Sheets and sending them on email
  • navigate_next Prepopulate patient details in BES assessments by creating secure prefill links without exposing PHI
  • navigate_next Limit access to patient data only for authorized personnel and minimize the risk of data breaches

These reviews are reproduced without modification from Google Workspace Marketplace.

July 23, 2023

5 stars

I am not tech savvy. I chose formesign to help create registration links for clients. Vipid has been great in assisting me. He goes above and beyond. My company now has moved from the stone age to modern age through the ability to use this feature. Of the many features I am impressed with, the ability to update a form without needing to regenerate a link is amazing. I often make mistakes and that ability allows me to fix mistakes without needing to change everything. Thank you!!!

— Sol Evans

February 16, 2024

1 stars

Does not work

— Myles Sicuro

October 31, 2023

5 stars

We needed a way to create forms with e-signatures and this app made it very easy. Support is also very quick and always helpful. Cannot recommend enough!

— Chris Henesy

July 12, 2023

5 stars

It very friendly to used. I love it. For my case multiple signature needed. it's supporting

— Senthil Kumar

November 27, 2023

5 stars

Yeah this is good for all

— luqman Khan

July 10, 2023

5 stars

We were looking for a way to have a signature option in our form. Formesign addon allowed us to collect signatures for the acknowledgment and consent forms. It was simple and easy to setup. Very useful addon for google forms.

— Joan S

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Eating disorder Care assessments
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