Behaviour Questionnaire

Current Behaviour Assessment (Past 6 Months)

Informant Report - For Partner, Family, or Friend

📧 How to Submit Your Results

After completing this questionnaire, you'll be able to:

Note: The patient will then forward your results to their clinician.

Important Notice:
This questionnaire is for information gathering purposes only and is not diagnostic. The responses you provide will be reviewed by a clinician as part of a comprehensive clinical assessment. Only a qualified healthcare professional can make diagnostic or treatment decisions. Please answer honestly based on your actual observations.
Privacy: All data is processed locally on your device. Nothing is sent anywhere until you choose to download and share your results file with your clinician.
Instructions for Informant: You have been asked to complete this questionnaire about someone close to you. Please rate their behaviour during the past six months.
📝 Answering Questions: You may leave questions blank if you're unsure or they don't apply. Don't guess - skipped items will be excluded from score calculations. However, try to answer as many as you can for accurate results.
0 of 28 items answered (28 skipped) (0%)

Information

Current Behaviour (Past 6 Months)

Rate the patient's behaviour during the past six months
0 = Never/rarely 1 = Sometimes 2 = Often 3 = Very often (several times per hour/day)

Impact on Daily Life

To what extent do these behaviours interfere with the patient's ability to function in each area?

0 = Never/rarely 1 = Sometimes 2 = Often 3 = Very often (several times per hour/day)