Please answer the questions and submit the form
Below is a list of phrases that describe certain feeling that people have. Rate the patients by finding the answer which best describes the extent to which he/she has these conditions. Select one of the five responses for each of the fourteen questions. 0 = Not present 1 = Mild 2 = Moderate 3 = Severe 4 = Very severe
Total score range of 0–56 <17 indicates mild severity 18–24 mild to moderate severity 25–30 moderate to severe
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