Please score each condition out of 10 (10 being the best it could be/no issue and 0 being the worst it could be). Add any other concerns/conditions you have in the blank spaces provided. Use the notes section to add any information if this is a particular problem. Several conditions have room for you to enter the locations in the body. Against numbness, you could write left foot, for example. Please be as accurate as you can as this will help you monitor how you feel – often we don’t know we’ve been out of pain until we are back in it! So even if you don’t have a problem with your skin, still give it a score as you may notice an improvement!

Wellbeing Questionnaire


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