(2025) LoCSA Feedback Survey

Feedback Survey

Level of Care Self-Assessment for an Eating Disorder (LoCSA)
Thank you for completing the Level of Care Self-assessment for an Eating Disorder (LoCSA). Now that you have reviewed your recommendations, we kindly ask that you complete the following feedback survey.

Consent
We would like to know how we can use your feedback. There are two ways your feedback can help us:

1. Program Evaluation or Research: Your responses will be de-identified (stripped of your personal information) and combined with others for analysis.

2. Promotional Use: Anonymous comments may be used in promotional materials and reports to help others learn about this tool.
May we use your feedback in program evaluation or research efforts?*

YesNo
May we use your feedback in promotional materials, either online or in print?*

YesNo

Your Experience
How did you learn about the self-assessment?

St. Joseph’s Eating Disorder ClinicBody BraveMy healthcare provider (e.g., primary care provider, dietitian, etc.)Other (please specify)

When you reviewed your recommended level of care, did it feel accurate to you?

Yes - I agreed with the recommendationSomewhat – I had questions or doubtsNo – I disagreed with the recommendationI didn’t understand the recommendation
Can you tell us more about your perspective? Your insights will help us improve future versions of the tool.

Do you plan on discussing your self-assessment results with a healthcare provider?

YesNoUndecidedI do not have a healthcare provider to discuss my results with

Has completing the self-assessment influenced your use of emergency services (e.g., emergency department) in any way?

Yes - I was able to avoid an emergency department visitYes - it helped me understand when I should go to the emergency departmentNo impactNot surePrefer not to sayOther (please specify)

	Strongly disagree	Disagree	Neither agree or disagree	Agree	Strongly agree
The self-assessment was easy to use
The questions were easy to understand
The "Why is This Question Asked" explanations were clear
The level of care recommendation page was easy to understand

Feedback Survey