Hospital Anxiety & Depression Questionnaire

Contact Details
I wake early and then sleep badly for the rest of the night.
I get very frightened or have panic feelings for apparently no reason at all.
I feel miserable and sad.
I feel anxious when I go out of the house on my own.
I have lost interest in things.
I get palpitations, or sensations of ‘butterflies’ in my stomach or chest.
I have a good appetite.
I feel scared or frightened.
I feel life is not worth living.
I still enjoy the things I used to.
I am restless and can’t keep still.
I am more irritable than usual.
I feel as if I have slowed down.
Worrying thoughts constantly go through my mind.

About This Form

Fields marked with a red asterisk are

Thank you for agreeing to complete this questionnaire. Please fill in all of the appropriate fields and click 'Send'.

A red asterix indicates a compulsory field.

By using this form you will be sending information about yourself across the Internet. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another method to notify us of your information.

Personal Information

Personal information retained on this system is stored in a secure data centre located in the UK and is treated as confidential.