Name of the patient:

Your Email Address:

Please type the email address that this form needs to be sent to. This is often the email address of your clinician who asked you to complete this form.

I do not worry about my health.

I occasionally worry about my health.

I spend much of my time worrying about my health.

I spend most of my time worrying about my health.

I notice aches/pains less than most other people (of my age).

I notice aches/pains as much as most other people (of my age).

I notice aches/pains more than most other people (of my age).

I am aware of aches/pains in my body all the time.

as a rule I am not aware of bodily sensations or changes.

sometimes I am aware of bodily sensations or changes.

I am often aware of bodily sensations or changes.

I am constantly aware of bodily sensations or changes.

resisting thoughts of illness is never a problem.

most of the time I can resist thoughts of illness.

I try to resist thoughts of illness but am often unable to do so.

thoughts of illness are so strong that I no longer even try to resist them.

as a rule I am not afraid that I have a serious illness.

I am sometimes afraid that I have a serious illness.

I am often afraid that I have a serious illness.

I am always afraid that I have a serious illness.

I do not have images (mental pictures) of myself being ill.

I occasionally have images of myself being ill.

I frequently have images of myself being ill.

I constantly have images of myself being ill.

I do not have any difficulty taking my mind off thoughts about my health.

I sometimes have difficulty taking my mind off thoughts about my health.

I often have difficulty in taking my mind off thoughts about my health.

Nothing can take my mind off thoughts about my health.

I am lastingly relieved if my doctor tells me there is nothing wrong.

I am initially relieved but the worries sometimes return later.

I am initially relieved but the worries always return later.

I am not relieved if my doctor tells me there is nothing wrong.

if I hear about an illness I never think I have it myself.

if I hear about an illness I sometimes think I have it myself.

if I hear about an illness I often think I have it myself.

if I hear about an illness I always think I have it myself.

if I have a bodily sensation or change I rarely wonder what it means.

if I have a bodily sensation or change I often wonder what it means.

if I have a bodily sensation or change I always wonder what it means.

if I have a bodily sensation or change I must know what it means.

I usually feel at very low risk for developing a serious illness.

I usually feel at fairly low risk for developing a serious illness.

I usually feel at moderate risk for developing a serious illness.

I usually feel at high risk for developing a serious illness.

I never think I have a serious illness.

I sometimes think I have a serious illness.

I often think I have a serious illness.

I usually think that I am seriously ill.

if I notice an unexplained bodily sensation I don’t find it difficult to think about other things.

if I notice an unexplained bodily sensation I sometimes find it difficult to think about other things.

if I notice an unexplained bodily sensation I often find it difficult to think about other things.

if I notice an unexplained bodily sensation I always find it difficult to think about other things.

my family/friends would say I do not worry enough about my health.

my family/friends would say I have a normal attitude to my health.

my family/friends would say I worry too much about my health.

my family/friends would say I am a hypochondriac.

For the following questions, please think about what it might be like if you had a serious illness of a type which particularly concerns you (e.g. heart disease, cancer, multiple sclerosis & so on). Obviously you cannot know for definite what it would be like; please give your best estimate of what you think might happen, basing your estimate on what you know about yourself and serious illness in general.

if I had a serious illness I would still be able to enjoy things in my life quite a lot.

if I had a serious illness I would still be able to enjoy things in my life a little.

if I had a serious illness I would be almost completely unable to enjoy things in my life.

if I had a serious illness I would be completely unable to enjoy life at all.

if I developed a serious illness there is a good chance that modern medicine would be able to cure me.

if I developed a serious illness there is a moderate chance that modern medicine would be able to cure me.

if I developed a serious illness there is a very small chance that modern medicine would be able to cure me.

if I developed a serious illness there is no chance that modern medicine would be able to cure me.

a serious illness would ruin some aspects of my life.

a serious illness would ruin many aspects of my life.

a serious illness would ruin almost every aspect of my life.

a serious illness would ruin every aspect of my life.

if I had a serious illness I would not feel that I had lost my dignity.

if I had a serious illness I would feel that I had lost a little of my dignity.

if I had a serious illness I would feel that I had lost quite a lot of my dignity.

if I had a serious illness I would feel that I had totally lost my dignity.

Tinnitus and hyperacusis therapy specialist unit

Health Anxiety

Each question in this section consists of a group of four statements. Please read each group of statements carefully and then select the one which best describes your feelings, over the past 2 weeks.