Core 10 English Stage: S Screening H Referral V Assessment F First therapy session P Pre-therapy (unspecified) U During therapy A ALast therapy session X Follow-up 1 Y Follow-up 2 Please enable JavaScript in your browser to complete this form. - Step 1 of 4Client ID *Date form completed *Therapist ID *Service ID *Episode *Session *Age *Gender *MaleFemaleNextIMPORTANT - PLEASE READ THIS FIRST This form has 10 statements about how you have been OVER THE LAST WEEK. Please read each statement and think how often you felt that way last week. Then tick the box which is closest to this.I have felt tense, anxious or nervous *Not at allOnly OccassionallySometimesOftenMost or all of the timeI have felt I have someone to turn to for support when needed *Not at allOnly OccassionallySometimesOftenMost or all of the timeI have felt able to cope when things go wrong *Not at allOnly OccassionallySometimesOftenMost or all of the timeTalking to people has felt too much for me *Not at allOnly OccassionallySometimesOftenMost or all of the timeI have felt panic or terror *Not at allOnly OccassionallySometimesOftenMost or all of the timeI made plans to end my life *Not at allOnly OccassionallySometimesOftenMost or all of the timeI have had difficulty getting to sleep or staying asleep *Not at allOnly OccassionallySometimesOftenMost or all of the timeI have felt despairing or hopeless *Not at allOnly OccassionallySometimesOftenMost or all of the timeI have felt unhappy *Not at allOnly OccassionallySometimesOftenMost or all of the timeUnwanted images or memories have been distressing me *Not at allOnly OccassionallySometimesOftenMost or all of the timeNextName *FirstLastE-mail *PreviousNextTotal (Clinical Score*)0Submit20004
