The following test will assess whether our treatment plan can help you.
You will immediately receive my results and recommendations. You will remain anonymous.
The test refers to how you felt and behaved in the last week. Answer ALL the questions Use the definitions and explanations provided by placing your mouse pointer over blue underlined words In the last seven days: 1 - Have you eaten regularly? not at all 1 2 3 4 5 6 7 8 9 10 all the time 2 - Have you exercised regularly? not at all 1 2 3 4 5 6 7 8 9 10 all the time 3 - Have you suffered from any of the following:-Tension | Palpitations | Headache | Stomach ache? not at all 1 2 3 4 5 6 7 8 9 10 all the time 4 - Were you tired? not at all 1 2 3 4 5 6 7 8 9 10 all the time 5 - Were you pressed for time? not at all 1 2 3 4 5 6 7 8 9 10 all the time 6 - Did you experience panic attacks? not at all 1 2 3 4 5 6 7 8 9 10 all the time 7 - Did you sleep well? not at all 1 2 3 4 5 6 7 8 9 10 all the time 8 - Did you eat well? not at all 1 2 3 4 5 6 7 8 9 10 all the time 9 - Were you energetic? not at all 1 2 3 4 5 6 7 8 9 10 all the time 10 - Were you sad? not at all 1 2 3 4 5 6 7 8 9 10 all the time 11 - Have you coped? not at all 1 2 3 4 5 6 7 8 9 10 all the time 12 - Were you critical? not at all 1 2 3 4 5 6 7 8 9 10 all the time 13 - Were you disappointed? not at all 1 2 3 4 5 6 7 8 9 10 all the time 14 - Did you feel you were losing control? not at all 1 2 3 4 5 6 7 8 9 10 all the time 15 - Did you feel you need to take control? not at all 1 2 3 4 5 6 7 8 9 10 all the time 16 - Did resting make you feel better? not at all 1 2 3 4 5 6 7 8 9 10 all the time 17 - Did resting make you feel worse? not at all 1 2 3 4 5 6 7 8 9 10 all the time 18 - Did you find it hard to cope because of your mood? not at all 1 2 3 4 5 6 7 8 9 10 all the time 19 - Were you angry? not at all 1 2 3 4 5 6 7 8 9 10 all the time 20 - Were you impatient with others? not at all 1 2 3 4 5 6 7 8 9 10 all the time 21 - Was it easy to concentrate? not at all 1 2 3 4 5 6 7 8 9 10 all the time 22 - In your lifetime, have you ever tried to commit suicide? Yes No 23 - In your lifetime, have you ever had any hallucinations that were NOT the direct result of being under the influence of drugs or alcohol? Yes No 24 - In your lifetime, have you ever suffered from delusions? Yes No 25 - In your lifetime, have you ever been hospitalized in a Mental Health Unit? Yes No 26 - Were you pessimistic? not at all 1 2 3 4 5 6 7 8 9 10 all the time 27 - Did you find yourself thinking continuously? not at all 1 2 3 4 5 6 7 8 9 10 all the time 28 - In the past six months, have you ever been physically violent towards another person? Yes No
In the last seven days:
1 - Have you eaten regularly?
not at all 1 2 3 4 5 6 7 8 9 10 all the time
2 - Have you exercised regularly?
3 - Have you suffered from any of the following:-Tension | Palpitations | Headache | Stomach ache?
4 - Were you tired?
5 - Were you pressed for time?
6 - Did you experience panic attacks?
7 - Did you sleep well?
8 - Did you eat well?
9 - Were you energetic?
10 - Were you sad?
11 - Have you coped?
12 - Were you critical?
13 - Were you disappointed?
14 - Did you feel you were losing control?
15 - Did you feel you need to take control?
16 - Did resting make you feel better?
17 - Did resting make you feel worse?
18 - Did you find it hard to cope because of your mood?
19 - Were you angry?
20 - Were you impatient with others?
21 - Was it easy to concentrate?
22 - In your lifetime, have you ever tried to commit suicide?
Yes No
23 - In your lifetime, have you ever had any hallucinations that were NOT the direct result of being under the influence of drugs or alcohol?
24 - In your lifetime, have you ever suffered from delusions?
25 - In your lifetime, have you ever been hospitalized in a Mental Health Unit?
26 - Were you pessimistic?
27 - Did you find yourself thinking continuously?
28 - In the past six months, have you ever been physically violent towards another person?
© Dr Michael Benjamin 2004-2007. All rights reserved.
