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Menu
Membership (Including Application Process)
The Psychodermatology Diploma
The Newsletter
The Next Congress
The Leaflets and Questionnaires
About Us
Links
Useful Documents and Latest Research
Hospital Anxiety & Depression Questionnaire
Last Updated: 01/01/1900
Contact Details
Name:
*
Date of Birth
*
Phone Number
Email Address
*
Questionnaire
Please read the following statements and check the most appropriate answer next to each
I feel tense or ‘wound up’.
*
Most of the time
A lot of the time
Other
From time to time, occasionally
Not at all
I still enjoy the things I used to enjoy
*
Definitely as much
Not quite so much
Only a little
Hardly at all
I get a sort of frightened feeling as if something awful is about to happen.
*
Very definitely and quite badly
Yes, but not too badly
A little, but it doesn’t worry me
Not at all
I can laugh and see the funny side of things.
*
As much as I always could
Not quite so much now
Definitely not so much now
Not at all
Worrying thoughts go through my mind.
*
A great deal of the time
Not quite so much now
Definitely not so much now
Not at all
I feel cheerful.
*
Not at all
Not often
Sometimes
Most of the time
I can sit at ease and feel relaxed.
*
Definitely
Usually
Not often
Not at all
I feel as if I am slowed down.
*
Nearly all the time
Very often
Sometimes
Not at all
I get a sort of frightened feeling like ‘butterflies’ in the stomach.
*
Not at all
Occasionally
Quite often
Very often
I have lost interest in my appearance.
*
Definitely
I don’t take as much care as I should
I may not take quite as much care
I take just as much care as ever
I feel restless as if I have to be on the move.
*
Very much indeed
Quite a lot
Not very much
Not at all
I look forward with enjoyment to things.
*
As much as I ever did
Rather less than I used to
Definitely less than I used to
Hardly at all
I get sudden feelings of panic.
*
Very often indeed
Quite often
Not very often
Not at all
I can enjoy a good book or radio or TV programme
*
Often
Sometimes
Not often
Very seldom
THIS FORM COLLECTS YOUR NAME, DATE OF BIRTH, EMAIL, OTHER PERSONAL INFORMATION AND MEDICAL DETAILS. THIS IS TO CONFIRM YOU ARE REGISTERED WITH THE PRACTICE, TO ALLOW THE PRACTICE TEAM TO CONTACT YOU AND ALSO TO UPDATE YOUR MEDICAL RECORDS HELD BY THE PRACTICE AND OUR PARTNERS IN THE NHS. PLEASE READ OUR PRIVACY POLICY TO DISCOVER HOW WE PROTECT AND MANAGE YOUR SUBMITTED DATA.
*
I consent to the practice collecting and storing my data from this form.
Submit Form
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