Hospital Anxiety & Depression Questionnaire

Contact Details
 
Questionnaire
I feel tense or ‘wound up’.
Please choose an option


I still enjoy the things I used to enjoy.
Please choose an option


I get a sort of frightened feeling as if something awful
is about to happen.
Please choose an option


I can laugh and see the funny side of things.
Please choose an option


Worrying thoughts go through my mind.
Please choose an option


I feel cheerful.
Please choose an option


I can sit at ease and feel relaxed.
Please choose an option


I feel as if I am slowed down.
Please choose an option


I get a sort of frightened feeling like ‘butterflies’ in the stomach.
Please choose an option


I have lost interest in my appearance.
Please choose an option


I feel restless as if I have to be on the move.
Please choose an option


I look forward with enjoyment to things.
Please choose an option


I get sudden feelings of panic.
Please choose an option


I can enjoy a good book or radio or TV programme.
Please choose an option


  

About This Form

Fields marked with a red asterisk are
compulsory.

Thank you for agreeing to complete this questionnaire. Please fill in all of the appropriate fields and click 'Send'.

A red asterix indicates a compulsory field.

Note:
By using this form you will be sending information about yourself across the Internet. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another method to notify us of your information.

Personal Information

Personal information retained on this system is stored in a secure data centre located in the UK and is treated as confidential.