Mental and Physical Health Score To complete the questionnaire, choose the most appropriate score between 0-4 for how you are feeling now. For example:0: If you don't feel this at all1: If you feel it a little2: If you feel it from time to time3: If you feel it quite a lot4: If you feel it most of the time Please fill in your contact details and proceed to Part Two by pressing Next. Full Name Your Email Mobile Employment 1 I get headaches 0 1 2 3 4 2 I feel nervous inside 0 1 2 3 4 3 I always have words or thoughts I cannot stop thinking 0 1 2 3 4 4 I have feelings of fainting or dizziness 0 1 2 3 4 5 I have lost sexual interest 0 1 2 3 4 6 I feel antagonistic to others 0 1 2 3 4 7 I feel my thoughts are controlled by someone else 0 1 2 3 4 8 I feel that others are to blame for most of my problems 0 1 2 3 4 9 I forget things a lot of the time 0 1 2 3 4 10 I get worried about being untidy or careless 0 1 2 3 4 1 out of 9 11 I easily get upset or irritated 0 1 2 3 4 12 I get a pain in my heart and chest area 0 1 2 3 4 13 I am afraid of open spaces or going out 0 1 2 3 4 14 I lack energy and feel sluggish 0 1 2 3 4 15 I have thoughts of killing myself 0 1 2 3 4 16 I hear voices that others cannot hear 0 1 2 3 4 17 I feel unsteady or get tremblings 0 1 2 3 4 18 I feel that most people are unreliable 0 1 2 3 4 19 I have a poor appetite 0 1 2 3 4 20 I find it easy to cry 0 1 2 3 4 2 out of 9 21 I feel shy and uneasy with people of the opposite sex 0 1 2 3 4 22 I have feelings of being trapped 0 1 2 3 4 23 I have sudden fears without any reason 0 1 2 3 4 24 I get uncontrolled outbursts of anger 0 1 2 3 4 25 I am afraid to go out alone 0 1 2 3 4 26 I blame myself for everything 0 1 2 3 4 27 I get pains in my lower back area 0 1 2 3 4 28 I find it difficult to get things done 0 1 2 3 4 29 I feel lonely 0 1 2 3 4 30 I feel low 0 1 2 3 4 3 out of 9 31 I worry too much about things 0 1 2 3 4 32 I have no interest in anything 0 1 2 3 4 33 I have feelings of fear and anxiety 0 1 2 3 4 34 I get easily hurt 0 1 2 3 4 35 I feel that others can read my mind 0 1 2 3 4 36 I feel others don’t understand or care about me 0 1 2 3 4 37 I feel others are unfriendly and disapprove of me 0 1 2 3 4 38 I have to do things very deliberately to make sure what I am doing is correct/right 0 1 2 3 4 39 I get a racing pounding heart feeling 0 1 2 3 4 40 I get feelings of nausea or upset stomach 0 1 2 3 4 4 out of 9 41 I get feelings of being inferior 0 1 2 3 4 42 I get feelings of pain or tenderness in my muscles 0 1 2 3 4 43 I feels others are watching me or talking about me 0 1 2 3 4 44 I find it hard to go to sleep 0 1 2 3 4 45 I need to do something over and over again to make sure I did it properly before 0 1 2 3 4 46 I find it difficult to make decisions 0 1 2 3 4 47 I am frightened to go on a train, bus, underground 0 1 2 3 4 48 I find it difficult to breathe 0 1 2 3 4 49 I feel hot/ cold waves running through my body 0 1 2 3 4 50 I avoid certain things, places and situations because they are frightening 0 1 2 3 4 5 out of 9 51 I have a feeling that my mind has gone blank 0 1 2 3 4 52 I feel numbness, pins/needles in some parts of my body 0 1 2 3 4 53 I feel a lump in my throat 0 1 2 3 4 54 I have feelings of hopelessness about my future 0 1 2 3 4 55 I find it hard to concentrate 0 1 2 3 4 56 I feel weak in different parts of my body 0 1 2 3 4 57 I feel tense or overexcited 0 1 2 3 4 58 I feel heaviness in my arms or legs 0 1 2 3 4 59 I think about death and what it would be like to die 0 1 2 3 4 60 I feel I am overeating 0 1 2 3 4 6 out of 9 61 I feel uneasy when others look at me and talk about me 0 1 2 3 4 62 I think thoughts that are not really me 0 1 2 3 4 63 I have impulsive feelings to hurt others 0 1 2 3 4 64 I wake up very early in the morning 0 1 2 3 4 65 I have certain acts that I must repeat many times in a certain pattern e.g. touch or clean things over and over again 0 1 2 3 4 66 I have worried or disturbed sleep 0 1 2 3 4 67 I have impulses to break or smash things 0 1 2 3 4 68 I have thoughts/ ideas that others don’t have 0 1 2 3 4 69 I feel preoccupied with myself when I am with others 0 1 2 3 4 70 I feel uneasy in crowds – shop/cinema/sport 0 1 2 3 4 7 out of 9 71 I feel all is hard to do – physically tired and exhausted 0 1 2 3 4 72 I feel anxiety or panic attacks 0 1 2 3 4 73 I don’t feel good when I go out of for a meal/drink 0 1 2 3 4 74 I often find myself in heated discussions 0 1 2 3 4 75 I feel nervous when I am alone 0 1 2 3 4 76 I feel others do not appreciate what I am doing 0 1 2 3 4 77 I feel alone even when in company 0 1 2 3 4 78 I feel restless and unable to sit still 0 1 2 3 4 79 I feel worthless 0 1 2 3 4 80 Familiar things feel strange and unreal 0 1 2 3 4 8 out of 9 81 I scream or throw things 0 1 2 3 4 82 I am afraid I may faint when out with others 0 1 2 3 4 83 I feel others would use me if they could 0 1 2 3 4 84 I feel disturbing sexual thoughts 0 1 2 3 4 85 I feel I should be punished for my sins 0 1 2 3 4 86 I have a compulsive need to get things done 0 1 2 3 4 87 I feel something is seriously physically wrong with me 0 1 2 3 4 88 I feel I am never really close to anyone 0 1 2 3 4 89 I have feelings of guilt 0 1 2 3 4 90 I think there is something wrong in my mind 0 1 2 3 4 "; 9 out of 9 [caption id="attachment_4566" align="alignnone" width="957"] Thank you for completing your personal score, it is time well spent. Your confidential answers will help me design your therapy needs.[/caption]I look forward to working with you.DianaThis completes the questionnaire, please press Submit to close the page. Time is Up! Time's up
