QUESTIONNAiRE

Please fill out this form as best and as honest as you can.

This information will be used to assist in developing a case study that will assist the Hard Cuddles organisation with the search for consistencies that are related to mental health.

Your name is required for admin purposed only and will not be shared with any other sources or parties.

Name

First Name

Last Name

Age

Height

Weight

Nationality/Background

Religion/Faith

Exercise

Hobbies

Favourite 5 Movies

Favourite 5 Books

Area you were raised

Area you live currently

Are your parents still married?

Relationship with mum

Relationship with Dad

Addictions

Mental Health

Previous Therapy

Video games? If yes how many hours a week do you spend playing/which games?

Strengths

Weaknesses

Police record

5 words you would use to describe yourself

5 words your partner or a loved one would use to describe your personality

Have you attempted to commit suicide

Have you had suicidal thoughts?

Greatest achievement?

Biggest disappointment?

Physical health?

Life goals?

Checkbox

I, am a consenting adult (above the age of 18) and have been asked to participate in this questionnaire. I give consent for Hard Cuddles, to collect and use the information that includes me to assist in developing a case study that will assist the Hard Cuddles organisation with the search for consistencies that are related to mental health. No names will be used when collating the data. I acknowledge that the student has clearly explained to me the intent of this questionnaire and the limits of confidentiality.

I Agree & Consent

QUESTIONNAiRE

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