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Core-10 Form

This Form has 10 statements about how you have been OVER THE LAST WEEK.

The questionnaire data is stored securely and confidentially. Please read each statement and think about how often you have felt this way over the last week. Use the drop-down box and choose which is applicable to you.

Please complete all of the questions.

Remember it is important your answers are about how you have been feeling over the last week.

→ Question 6 asks about planned suicide or self-harm.

→ Question 6 is not asking you about suicidal thoughts, but if you have made specific and detailed plans to end your life over the last week.

  • Date Format: DD slash MM slash YYYY
  • Over the last week

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