GENERAL HEALTH QUESTIONNAIRE
Time duration is 5 minutes
12 questions.
Have you recently been able to concentrate on whatever you're doing?
*
Better than usual
Same as usual
Less than usual
Much less than usual
Have you recently lost much sleep over worry?
*
Not at all
No more than usual
Rather more than usual
Much more than usual
Have you recently felt that you were playing a useful part in things?
*
More so than usual
Same as usual
Less so than usual
Much less than usual
Have you recently felt capable of making decisions about things?
*
More so than usual
Same as unsual
Less so than unsual
Much less capable
Have you recently felt constantly under strain?
*
Not at all
No more than usual
Rather more than usual
Much more than usual
Have you recently felt you couldn't overcome your difficulties?
*
Not at all
No more than usual
Rather more than usual
Much more than usual
Have you recently been able to enjoy your normal day-to-day activities?
*
More so than usual
Same as usual
Less so than usual
Much less than usual
Have you recently been able to face up to problems?
*
More so than usual
Same as usual
Less able than usual
Much less able
Have you recently been feeling unhappy or depressed?
*
Not at all
No more than usual
Rather more than usual
Much more than usual
Have you recently been losing confidence in yourself?
*
Not at all
No more than usual
Rather more than usual
Much more than usual
Have you recently been thinking of yourself as a worthless person?
*
Not at all
No more than usual
Rather more than usual
Much more than usual
Have you recently been feeling reasonably happy, all things considered?
*
More so than usual
About the same as usual
Less so than usual
Much less than usual
Name
*
First Name
Last Name
Email
*
example@example.com
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*
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