How many of these episodes have you had in the last month on average? All the time Daily (1 or more each day) Weekly (1 or more each week but not daily attacks) Less than weekly (1 or more over the last month) None 4.How much do the symptoms get in the way of you living your life the way you want to? Or how much do they stop you from doing the things you would like to do? Very much for example, you don’t go out alone unless you absolutely have to – A moderate amount for example, you go out but you worry you might have an episode while – you are out Not too much for example, you do all the things you want to do and manage any episodes as – needed Not at all for example, you know that you can manage your attacks (or early signs’) so – ‘warning that they don’t affect what you want to do Not at all there have been no episodes – 5.If you did not have these symptoms, would you participate more in the following situations/ activities? Family Yes No Social outings/ friends Yes No Work Yes No Household duties Yes No Hobbies Yes No Physical activity Yes No 6.Compared to 3 months ago, has there been a change in how often your symptoms happen? They happen more often About the same frequency (skip the next question) They happen less often 6a.If your symptoms are more or less frequent, do you know what has caused this? Yes please describe: – No
How many of these episodes have you had in the last month on average? All the time Daily (1 or more each day) Weekly (1 or more each week but not daily attacks) Less than weekly (1 or more over the last month) None 4.How much do the symptoms get in the way of you living your life the way you want to? Or how much do they stop you from doing the things you would like to do? Very much – for example, you don’t go out alone unless you absolutely have to A moderate amount – for example, you go out but you worry you might have an episode while you are out Not too much – for example, you do all the things you want to do and manage any episodes as needed Not at all – for example, you know that you can manage your attacks (or early ‘warning signs’) so that they don’t affect what you want to do Not at all – there have been no episodes 5.If you did not have these symptoms, would you participate more in the following situations/ activities? Family Yes No Social outings/ friends Yes No Work Yes No Household duties Yes No Hobbies Yes No Physical activity Yes No 6.Compared to 3 months ago, has there been a change in how often your symptoms happen? They happen more often About the same frequency (skip the next question) They happen less often 6a.If your symptoms are more or less frequent, do you know what has caused this? Yes – please describe: No
BFuNCQ-Version-3.docx