A Balanced Check--Pre-op Survey 5-2023 Question Title * 1. Before amputation, how often did thoughts of your upcoming amputation interfere with your day to day activities?Please score your response with 0=Not at all and 10=The most 0-Not at all 1 2 3 4 4 5--Moderately 6 7 8 9 10--The most Question Title * 2. Before my amputation, the thought of needing an amputation interfered with my ability to concentrate.Please score your response with 0=Not at all and 10=Often 0--Not at all 1 2 3 4 5--Moderately 6 7 8 9 10--Often Question Title * 3. Because of your upcoming amputation, how much did not knowing what to expect with amputation interfere with your family life?Please score your response with 0=Not at all and 10=Often 0-Not at all 1 2 3 4 5--Moderately 6 7 8 9 10--Often Question Title * 4. Before amputation, how often did thoughts of your upcoming amputation interfere with your day to day activities?Please score your response with 0=Not at all and 10=Often 0--Not at all 1 2 3 4 5--Moderately 6 7 8 9 10--Often Question Title * 5. Because of your upcoming amputation, how often did anxiety, and not knowing what to expect with amputation, interfere with the things you usually did for fun?Please score your response with 0=Not at all and 10=Often 0--Not at all 1 2 3 4 5--Moderately 6 7 8 9 10--Often Question Title * 6. Before amputation, how often did anxiety interfere with your close personal relationships?Please score your response with 0=Not at all and 10=Often 0--Not at all 1 2 3 4 5--Moderately 6 7 8 9 10--Often Question Title * 7. Before amputation, not knowing what to expect made me feel depressed.Please score your response with 0=Not at all and 10=Often 0--Not at all 1 2 3 4 5--Moderately 6 7 8 9 10--Often Question Title * 8. Before amputation I felt l emotionally tense. Please score your response with 0=Not at all and 10=Often 0--Not at all 1 2 3 4 5--Moderately 6 7 8 9 10--Often Done