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Avoidant/Restrictive Food Intake Disorders Screen (NIAS)
First Name
Email
Last Name
Date
Please answer the following nine questions:
1. I am a picky eater.
Strongly Disagree
Disagree
Slightly Disagree
Slightly Agree
Agree
Strongly Agree
2. I dislike most of the foods that other people eat.
Strongly Disagree
Disagree
Slightly Disagree
Slightly Agree
Agree
Strongly Agree
3. The list of food that I like and will eat is shorter than the list of food I won't eat.
Strongly Disagree
Disagree
Slightly Disagree
Slightly Agree
Agree
Strongly Agree
4. I am not very interested in eating; I seem to have a smaller appetite than other people.
Strongly Disagree
Disagree
Slightly Disagree
Slightly Agree
Agree
Strongly Agree
5. I have to push myself to eat regular meals throughout the day, or to eat a large enough amount of food at meals.
Strongly Disagree
Disagree
Slightly Disagree
Slightly Agree
Agree
Strongly Agree
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