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

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

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

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

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

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

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

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