Please click here to continue to the Questionnaire if you have been asked by your doctor to complete it.
This page is hosted externally (by another provider). Once you have completed the questionnaire, save your results as a PDF, or print them out and bring them to your next appointment.
There are no right or wrong answers. Do not spend too much time on any question.
Your answers are not saved or transmitted anywhere, and you will not be asked to enter your personal details. However this page will save in your phone’s history, so you may wish to clear your browser history if you are concerned about other people seeing that you have accessed this website (click here for instructions) and delete the document with the results once you are done with it.