Introduction

The following questionnaire is normally completed in conjunction with a consultation with Sharon or Dawson of FamilyWorks.

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Your Name (Parent)

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Baby's due date or date of birth

Date

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Mobile

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Email

Over the past month, how often have you experienced the following?

Please select the response that most closely describes your experience for each question.

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1. Worry about the baby/pregnancy

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2. Fear that harm will come to the baby

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3. A sense of dread that something bad is going to happen

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4. Worry about many things

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5. Worry about the future

 

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