Eating Assessment Tool (EAT-10)

This questionnaire helps to measure swallowing difficulties. Simply answer 10 short questions to what extent do you experience the following problems.

1

Below are some general statements that people with swallowing problems might mention. In the last month, how true have the following statements been for you? Please select one answer per statement.

Degree of Problem
0 - 4 Rating Scale

0 = Never
1 = Very much True
2 = Quite a bit True
3 = Somewhat True
4 = A Little True

My swallowing problem has caused me to lose weight.

None

2

Below are some general statements that people with swallowing problems might mention. In the last month, how true have the following statements been for you? Please select one answer per statement.

Degree of Problem
0 - 4 Rating Scale

0 = Never
1 = Very much True
2 = Quite a bit True
3 = Somewhat True
4 = A Little True

My swallowing problems interferes with my ability to go out for meals.

None

3

Below are some general statements that people with swallowing problems might mention. In the last month, how true have the following statements been for you? Please select one answer per statement.

Degree of Problem
0 - 4 Rating Scale

0 = Never
1 = Very much True
2 = Quite a bit True
3 = Somewhat True
4 = A Little True

Swallowing liquids takes extra effort.

None

4

Below are some general statements that people with swallowing problems might mention. In the last month, how true have the following statements been for you? Please select one answer per statement.

Degree of Problem
0 - 4 Rating Scale

0 = Never
1 = Very much True
2 = Quite a bit True
3 = Somewhat True
4 = A Little True

Swallowing solids takes extra effort.

None

5

Below are some general statements that people with swallowing problems might mention. In the last month, how true have the following statements been for you? Please select one answer per statement.

Degree of Problem
0 - 4 Rating Scale

0 = Never
1 = Very much True
2 = Quite a bit True
3 = Somewhat True
4 = A Little True

Swallowing pills takes extra effort.

None

6

Below are some general statements that people with swallowing problems might mention. In the last month, how true have the following statements been for you? Please select one answer per statement.

Degree of Problem
0 - 4 Rating Scale

0 = Never
1 = Very much True
2 = Quite a bit True
3 = Somewhat True
4 = A Little True

Swallowing is painful.

None

7

Below are some general statements that people with swallowing problems might mention. In the last month, how true have the following statements been for you? Please select one answer per statement.

Degree of Problem
0 - 4 Rating Scale

0 = Never
1 = Very much True
2 = Quite a bit True
3 = Somewhat True
4 = A Little True

The pleasure of eating is affected by my swallowing.

None

8

Below are some general statements that people with swallowing problems might mention. In the last month, how true have the following statements been for you? Please select one answer per statement.

Degree of Problem
0 - 4 Rating Scale

0 = Never
1 = Very much True
2 = Quite a bit True
3 = Somewhat True
4 = A Little True

When I swallow food sticks in my throat.

None

9

Below are some general statements that people with swallowing problems might mention. In the last month, how true have the following statements been for you? Please select one answer per statement.

Degree of Problem
0 - 4 Rating Scale

0 = Never
1 = Very much True
2 = Quite a bit True
3 = Somewhat True
4 = A Little True

I cough when I eat.

None

10

Below are some general statements that people with swallowing problems might mention. In the last month, how true have the following statements been for you? Please select one answer per statement.

Degree of Problem
0 - 4 Rating Scale

0 = Never
1 = Very much True
2 = Quite a bit True
3 = Somewhat True
4 = A Little True

Swallowing is stressful.

None

Name

DOB

Phone number

Please contact me by email

Please contact me by phone

Time's up

Belafsky, P. C., et al. (2008). "Validity and reliability of the Eating Assessment Tool (EAT-10)." Ann Otol Rhinol Laryngol 117(12): 919-924.

Eating Assessment Tool (EAT-10)

This questionnaire helps to measure swallowing difficulties. Simply answer 10 short questions to what extent do you experience the following problems.

1

Below are some general statements that people with swallowing problems might mention. In the last month, how true have the following statements been for you? Please select one answer per statement.

Degree of Problem
0 - 4 Rating Scale

2

Below are some general statements that people with swallowing problems might mention. In the last month, how true have the following statements been for you? Please select one answer per statement.

Degree of Problem
0 - 4 Rating Scale

3

Below are some general statements that people with swallowing problems might mention. In the last month, how true have the following statements been for you? Please select one answer per statement.

Degree of Problem
0 - 4 Rating Scale

4

Below are some general statements that people with swallowing problems might mention. In the last month, how true have the following statements been for you? Please select one answer per statement.

Degree of Problem
0 - 4 Rating Scale

5

Below are some general statements that people with swallowing problems might mention. In the last month, how true have the following statements been for you? Please select one answer per statement.

Degree of Problem
0 - 4 Rating Scale

6

Below are some general statements that people with swallowing problems might mention. In the last month, how true have the following statements been for you? Please select one answer per statement.

Degree of Problem
0 - 4 Rating Scale

7

Below are some general statements that people with swallowing problems might mention. In the last month, how true have the following statements been for you? Please select one answer per statement.

Degree of Problem
0 - 4 Rating Scale

8

Below are some general statements that people with swallowing problems might mention. In the last month, how true have the following statements been for you? Please select one answer per statement.

Degree of Problem
0 - 4 Rating Scale

9

Below are some general statements that people with swallowing problems might mention. In the last month, how true have the following statements been for you? Please select one answer per statement.

Degree of Problem
0 - 4 Rating Scale

10

Below are some general statements that people with swallowing problems might mention. In the last month, how true have the following statements been for you? Please select one answer per statement.

Degree of Problem
0 - 4 Rating Scale

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This questionnaire helps to measure swallowing difficulties. Simply answer 10 short questions to what extent do you experience the following problems.

1

Below are some general statements that people with swallowing problems might mention. In the last month, how true have the following statements been for you? Please select one answer per statement.

Degree of Problem 0 - 4 Rating Scale

2

Below are some general statements that people with swallowing problems might mention. In the last month, how true have the following statements been for you? Please select one answer per statement.

Degree of Problem 0 - 4 Rating Scale

3

Below are some general statements that people with swallowing problems might mention. In the last month, how true have the following statements been for you? Please select one answer per statement.

Degree of Problem 0 - 4 Rating Scale

4

Below are some general statements that people with swallowing problems might mention. In the last month, how true have the following statements been for you? Please select one answer per statement.

Degree of Problem 0 - 4 Rating Scale

5

Below are some general statements that people with swallowing problems might mention. In the last month, how true have the following statements been for you? Please select one answer per statement.

Degree of Problem 0 - 4 Rating Scale

6

Below are some general statements that people with swallowing problems might mention. In the last month, how true have the following statements been for you? Please select one answer per statement.

Degree of Problem 0 - 4 Rating Scale

7

Below are some general statements that people with swallowing problems might mention. In the last month, how true have the following statements been for you? Please select one answer per statement.

Degree of Problem 0 - 4 Rating Scale

8

Below are some general statements that people with swallowing problems might mention. In the last month, how true have the following statements been for you? Please select one answer per statement.

Degree of Problem 0 - 4 Rating Scale

9

Below are some general statements that people with swallowing problems might mention. In the last month, how true have the following statements been for you? Please select one answer per statement.

Degree of Problem 0 - 4 Rating Scale

10

Below are some general statements that people with swallowing problems might mention. In the last month, how true have the following statements been for you? Please select one answer per statement.

Degree of Problem 0 - 4 Rating Scale

Book an Appointment Contact MSAC

Have some questions? View FAQs Database

Open Map Location ( Minimise )

Contact

Talk to Us

Email

Contact Form

Degree of Problem
0 - 4 Rating Scale

Degree of Problem
0 - 4 Rating Scale

Degree of Problem
0 - 4 Rating Scale

Degree of Problem
0 - 4 Rating Scale

Degree of Problem
0 - 4 Rating Scale

Degree of Problem
0 - 4 Rating Scale

Degree of Problem
0 - 4 Rating Scale

Degree of Problem
0 - 4 Rating Scale

Degree of Problem
0 - 4 Rating Scale

Degree of Problem
0 - 4 Rating Scale

Book an Appointment
Contact MSAC

Have some questions?
View FAQs Database