ELDP Questionnaire
Please complete this questionnaire. Don't think about each question for long, go with your gut reaction. Please only select one answer. 5 is All the time and 1 is Hardly Ever
Date
*
-
Month
-
Day
Year
Date
Event
If applicable
Name
*
First Name
Last Name
Date of Birth
Gender
*
Male
Female
Prefer not to say
I feel confident in myself
*
5
4
3
2
1
I am able to recognise my limits
*
5
4
3
2
1
I often get angry for no very obvious reason
*
5
4
3
2
1
I can talk about my feelings
*
5
4
3
2
1
I find it difficult to concentrate
*
5
4
3
2
1
I am able to handle my emotions well
*
5
4
3
2
1
I feel responsible for other people's problems
*
5
4
3
2
1
I find it easy to talk to people
*
5
4
3
2
1
I get upset or frustrated by little things
*
5
4
3
2
1
I like going out and meeting new people
*
5
4
3
2
1
I can see that I have choices
*
5
4
3
2
1
I find it difficult to make decisions
*
5
4
3
2
1
I am able to deal with situations
*
5
4
3
2
1
I get upset or angry when someone criticises me
*
5
4
3
2
1
I can assert myself when I need to
*
5
4
3
2
1
I feel I have the language to help someone who is upset or angry
*
5
4
3
2
1
I can bounce back when faced with difficulties
*
5
4
3
2
1
I feel in tune with other people
*
5
4
3
2
1
I do not have words to talk about my feelings
*
5
4
3
2
1
I tend to go over and over problems in my head
*
5
4
3
2
1
I can take responsibility for myself
*
5
4
3
2
1
I feel I am approachable
*
5
4
3
2
1
I am able to say "No"
*
5
4
3
2
1
My emotions feel chaotic
*
5
4
3
2
1
I take time off for myself / to relax / to have fun
*
5
4
3
2
1
I am able to recognise my emotions
*
5
4
3
2
1
I need medication or counselling to help me get through situations
*
5
4
3
2
1
I tend to blame others easily
*
5
4
3
2
1
I feel positive about life
*
5
4
3
2
1
I feel able to manage difficult relationships
*
5
4
3
2
1
I feel there is purpose in life
*
5
4
3
2
1
I can think clearly
*
5
4
3
2
1
I let myself take my anger out on others
*
5
4
3
2
1
I feel I understand why people get distressed
*
5
4
3
2
1
Any further comments?
Submit
Should be Empty: