Behaviour Questionnaire

Current and Childhood Behaviour Assessment

Patient Self-Report

📧 How to Submit Your Results

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

Important Notice:
This questionnaire is for information gathering purposes only and is not diagnostic. The responses you provide will be reviewed by your 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 experiences.
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.
📝 Answering Questions: You may leave questions blank if you're unsure or they don't apply to you. 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 54 items answered (54 skipped) (0%)

Your Information

Part 1: Current Behaviour (Past 6 Months)

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

Age When Problems Began

Impact on Daily Life (Current)

To what extent do these behaviours interfere with your ability to function in each area?

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

Part 2: Childhood Behaviour (Ages 7-12)

Important: Rate your behaviour between 7 and 12 years of age. Try to remember how you were during those childhood years.
0 = Never/rarely 1 = Sometimes 2 = Often 3 = Very often (several times per hour/day)

Impact on Daily Life (Childhood, ages 7-12)

To what extent did these behaviours interfere with your functioning between ages 7-12?

0 = Never/rarely 1 = Sometimes 2 = Often 3 = Very often (several times per hour/day)
0 of 54 items answered (54 skipped) (0%)
✓ Latest response recorded
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