ONLINE CONFIDENTIAL ASSESSMENT

By Fernando Gomez – Consultant Clinical Psychologist

Results will remain strictly confidential and a reply will be sent you.

Please read each statement and tick a number between 0, 1, 2 or 3 which indicates how much the statement applied to you over the past week. There are no right or wrong answers. Do not spend too much time on any statement. The rating is as follows:

1. Did not apply to me at all – NEVER
2. Applied to me to some degree, or some of the time – SOMETIMES
3. Applied to me to a considerable degree, or a good part of the time – OFTEN
4. Applied to me very much, or most of the time – ALMOST ALWAYS

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