0524 Assessment of wellbeing in Children and Young People with Type 1 Diabetes Online Forms Current User: Not Logged In
Completion Errors
Wellbeing Questionnaire
Name of child/young person
Add Label Here
Date of Birth
//
Todays Date
//
About this questionnaire
Diabetes teams in the UK make sure that every year, each person is asked about their overall emotional wellbeing and how they are getting on with their Diabetes. This is because diabetes teams want to make sure that everyone gets a chance to meet with a Clinical Psychologist, at times when this could be helpful, if they wish.

These questions are about some of the difficulties that people with diabetes type 1 and their families may experience. The questions help us to find out how you are feeling at the moment. In your clinic appointment you can discuss your answers and any extra support if you wish.

Your answers will be kept following NHS guidelines for confidential health Records.
Please tick this box if you do not wish to take part
Does not wish to take part
1.    Please tell us who is completing this form:
 
Parents/Guardians: please use your knowledge of your child to decide whether they can complete this on their own, with help from you, or if you need to complete it on their behalf.
The person completing this form is:
Parent/Guardian for my child
Parent/Guardian in discussion with my child
On my own about my diabetes
2. Is there anything you would like to ask or discuss in clinic today?
Child/Young Persons Questions
Parents/Guardians Questions
PTO