Sexual preference |
Please indicate your sexuality. Lesbian Bisexual Other (please specify) |
Would you describe yourself as.. Lesbian Bisexual Straight Don't know Other..... |
How would you describe yourself? Lesbian, Gay, Bisexual, Heterosexual, Other |
How would you describe your sexual orientation or sexuality – Lesbian, Gay, Bisexual, Heterosexual, Other |
Smoking |
I smoke |
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Do you smoke; how many per day; age started smoking: |
Do you smoke; how many per day; ever tried to quit? |
Problem with alcohol |
I regularly drink heavily (more than 10 pints or equivalent a week or I would like to cut down/stop drinking) |
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Do you drink alcohol; how much in a typical week; do you think the amount you drink is a problem? |
How often might you drink 6 or more units of alcohol in one session? 4 questions to assess 'problem' drinking' |
Mental health problems/depression |
I have experienced emotional/mental health problems |
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Have you ever been diagnosed with depression? |
Have you ever been diagnosed with depression? |
Suicide attempts |
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Have you ever thought of taking your own life; have you ever attempted to take your own life? |
Have you ever thought of taking your own life; have you ever attempted to take your own life? |
Eating disorders |
I have/have had an eating disorder eg anorexia nervosa, bulimia nervosa |
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N/A |
Have you ever been diagnosed with an eating disorder? |
Out to GP |
Are you out to your current GP? Yes/no |
Are you out to him/her? Yes/no/don't know |
Are you out to your GP? |
Have you disclosed your sexuality to your GP? |
GP reaction |
If you have come out to your GP, please briefly describe the reaction you received. (Free text coded as positive, indifferent or negative.) |
What response did you get when you came out? (Free text coded as positive, indifferent, negative or no explanation) |
N/A |
How did they react when they became aware? |