This page provides two different questionnaires. One for infants and children, and one for adults. Adults may have to complete the children's questionnaire if your current problem started in infancy or during your childhood years. However, if your current and main complaint arose in adult life the adult questionnaire would be the appropriate one for you.

Please download the questionnaire first to a file. Once it has been completed in detail, please phone 0219030743 to obtain the e-mail address to which it can be sent.




© Dr HJD Jeggels 2006.