Eating Assessment Tool (EAT-10)

This questionnaire helps to measure swallowing difficulties. These are statement many people have used to describe difficulty with swallowing/eating. To what extent do you experience the following problems? Please select the most appropriate response for each statement.

0 = No problem
1 = Mild problem
2 = Mild-Moderate problem
3 = Moderate problem
4 = Severe problem

The results of these questions will be sent to your Speech Pathologist who will discuss them with you at your next appointment.

NB:  Before completing this form, please ensure that you have made an appointment with Jenny Matthews, through Redlands Specialist Centre, (07) 3193 5436. These forms are specifically designed for patients to complete prior to their initial assessment and after you have made an appointment, you will be advised which forms are necessary for you to complete, depending on the reason for your appointment. Because these forms do not collect your contact information, if you complete these forms before making an appointment we will have no way of contacting you to discuss the results. 

0 = No problem / 1 = Mild problem / 2 = Mild-Moderate problem / 3 = Moderate problem / 4 = Severe problem
0 = No problem / 1 = Mild problem / 2 = Mild-Moderate problem / 3 = Moderate problem / 4 = Severe problem
0 = No problem / 1 = Mild problem / 2 = Mild-Moderate problem / 3 = Moderate problem / 4 = Severe problem
0 = No problem / 1 = Mild problem / 2 = Mild-Moderate problem / 3 = Moderate problem / 4 = Severe problem
0 = No problem / 1 = Mild problem / 2 = Mild-Moderate problem / 3 = Moderate problem / 4 = Severe problem
0 = No problem / 1 = Mild problem / 2 = Mild-Moderate problem / 3 = Moderate problem / 4 = Severe problem
0 = No problem / 1 = Mild problem / 2 = Mild-Moderate problem / 3 = Moderate problem / 4 = Severe problem
0 = No problem / 1 = Mild problem / 2 = Mild-Moderate problem / 3 = Moderate problem / 4 = Severe problem
0 = No problem / 1 = Mild problem / 2 = Mild-Moderate problem / 3 = Moderate problem / 4 = Severe problem
0 = No problem / 1 = Mild problem / 2 = Mild-Moderate problem / 3 = Moderate problem / 4 = Severe problem
Please enter your email address.

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