Shop T36 Murray Bridge Marketplace, Australia
120 Waterloo Corner Road, Paralowie, South Australia
booknow.allure@gmail.com
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Shop T36 Murray Bridge Marketplace, Adelaide, Australia
+61 402 378 365
booknow.allure@gmail.com
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BDDQ
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BDDQ
Body Dysmorphic Disorder Questionnaire
(BDDQ)
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Please enable JavaScript in your browser to complete this form.
that social think
Name
Please read each question carefully and select what is true for you..
Date Of Birth
Date Of Birth
Are you worried about how you look?
*
Yes
No
If yes, do you think about your appearance problems a lot?
*
Yes
No
If yes, please list areas of concern:
If you have answered no to above questions you have finished, otherwise please continue below:
Is your main concern about your appearance that you aren't thin enough or will become too fat?
*
Yes
No
What effect has the issues with your appearance had on your life?
Caused you emotional distress?
*
Yes
No
Significantly interfered with your social life?
*
Yes
No
Patient Signature
Patient Name
Date
Submit
