PSORIASIS QUESTIONNAIRE

Please print the form, answer the following questions and hand it to your doctor. It will help make the most of your visit to this surgery. Read each question carefully and tick the relevant multiple-choice answer. You can do this while waiting for your appointment, and when the doctor does see you, simply hand it over.

Do you ever find yourself feeling aggressive, frustrated or embarrassed because of your psoriasis?
a) very much indeed
b) a lot
c) a little
d) not at all

Does your psoriasis interfere with your social life or relationships with family and friends?
a) a lot - all activities
b) quite a lot - most activities
c) a little - only some activities
d) not at all

Do you avoid changing clothes in public or going swimming/playing sports because of your psoriasis?
a) all the time
b) most of the time
c) occasionally
d) not at all

How do you feel about what your skin looks like?
a) depressed and miserable
b) frequently concerned
c) slightly concerned
d) not worried at all

In general, how often do you feel your life is governed by your skin problem?
a) all the time
b) most of the time
c) occasionally
d) not at all