CareCreds
Patients earn CareCreds for completing this Research Questionnaire
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ENTRANCE RESEARCH QUESTIONNAIRE TO HELP IMPROVE OUR MANAGEMENT OF ADDICTION

The Mobile Phone Number that is your i-bet-me identity

Your email address (Optional):
Your First Name (Optional):
Your Sex:
Your Date of Birth (e.g. 01/02/1994):
 * required

CARECREDS EARNED THIS MONTH

VALID BODY-CARECREDS EARNED THIS MONTH

VALID MIND-CARECREDS EARNED THIS MONTH

This patient is having care from me for the above I will confirm this if emailed (see below):

VALID FRIEND AND FAMILY-CARECREDS EARNED THIS MONTH

This patient gave me care as above. I will confirm this if emailed (see below):

VALID SOCIAL-CARECREDS EARNED THIS MONTH

This patient volunteered this care as above. I will confirm this if emailed (see below):
How severe a problem is your Addiction now?
How much did your habit(s) cost you to the nearest pound yesterday?
Are you or have you had food addiction?
Are you now or have you ever been a heavy smoker?
Do you have or have you had Alcoholism?
Do you or have you had Class A addiction ( e.g. Heroin or Cocaine) ?
Do you have addiction to other street drugs (e.g. Cannabis) ?
Do you have addiction to prescribed drugs (e.g. Benzodiazepines or Codeine) ?
Do you have a behavioural addiction  (e.g. Gambling or Sexual Addiction) ?
How often are you so stressed that you feel like using your addiction to relieve it?

Is shortage of money one of your main stresses?

Are you suffering from  a lot of stress from problems you could help solve? e.g. Loneliness, conflict with others etc 

Do you suffer a lot of stress from problems you cannot solve e.g. Bereavement, permanent disability etc ?

During the last two weeks have you had frequent personality changes that upset other people?

During  the past month have you OFTEN been bothered by little interest or pleasure in doing things?

During the past month have you often been bothered by feeling down, depressed or hopeless?

How often have you made an effort to solve your stressful problems in the last two weeks?

How often have you thought obsessionally about your addiction and/or felt bad cravings to do it in the last two weeks?

How much are you able to enjoy your family, exercise, hobbies or work in the last two weeks?

During the past month how how often has your addiction caused you embarrassment?

During the past month how generally happy and relaxed or unhappy and stressed have you felt ?

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What has helped your addiction most? Please write in this box anything you feel would also help others.
Do you wish to email us with attached photos of your injection sites to let us monitor your progress?
Are you happy to have your anonymised data analysed and published to help others?

 

 

THANKS FOR DOING THIS. YOU WILL EARN CARECREDS AFTER PRESSING THE SUBMIT BUTTON

FOLLOW-UP RESEARCH QUESTIONNAIRE 

The Mobile Phone Number that is your i-bet-me identity

Your email address (Optional):
Your First Name (Optional):
Your Sex:
Your Date of Birth (e.g. 01/02/1994):
 * required

CARECREDS EARNED THIS MONTH

VALID BODY-CARECREDS EARNED THIS MONTH

VALID MIND-CARECREDS EARNED THIS MONTH

This patient is having care from me for the above I will confirm this if emailed (see below):

VALID FRIEND AND FAMILY-CARECREDS EARNED THIS MONTH

This patient gave me care as above. I will confirm this if emailed (see below):

VALID SOCIAL-CARECREDS EARNED THIS MONTH

This patient volunteered this care as above. I will confirm this if emailed (see below):
How severe a problem is your Addiction now?
How much did your habit(s) cost you to the nearest pound yesterday?
How often are you so stressed that you feel like using your addiction to relieve it?

Is shortage of money one of your main stresses?

Are you suffering from  a lot of stress from problems you could help solve? e.g. Loneliness, conflict with others etc 

Do you suffer a lot of stress from problems you cannot solve e.g. Bereavement, permanent disability etc ?

During the last two weeks have you had frequent personality changes that upset other people?

During  the past month have you OFTEN been bothered by little interest or pleasure in doing things?

During the past month have you often been bothered by feeling down, depressed or hopeless?

How often have you made an effort to solve your stressful problems in the last two weeks?

How often have you thought obsessionally about your addiction and/or felt bad cravings to do it in the last two weeks?

How much are you able to enjoy your family, exercise, hobbies or work in the last two weeks?

During the past month how how often has your addiction caused you embarrassment?

During the past month how generally happy and relaxed or unhappy and stressed have you felt ?

NewThym.jpg

What has helped your addiction most? Please write in this box anything you feel would also help others.
Are you happy to have your anonymised data analysed and published to help others?

 

 

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