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The Hammam Spa in London – Casa Spa
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Home
About Us
Gallery
Editorials
Facilities
Casa Spa Facilities
Spa Etiquette and Terms
Hammam Spa Packages
Massages & Facial (LPG)
Gift Vouchers
News
News & Blog
Special Offer Packages
After Shopping Hammam
Escape Package Spa Day
Exotic Rural Hammam Spa Day
Hen Package
Ladies Retreat Spa Day
Traditional Moroccan Hammam Spa Day
Summer Pampering Spa Day
Private Spa Rental
Contact Us
Terms and Conditions
Privacy Policy
Cookie Policy
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Health Form
Name
Email
Address
The aim of this questionnaire is to measure how much your skin problem has affected your life OVER THE LAST WEEK. Please choose one box for each question.
1. Over the last week, how
itchy, sore, painful
or
stinging
has your skin been?
Very much
A lot
A litte
Not at all
2. Over the last week, how
embarassed
or
self conscious
have you been because of your skin?
Very much
A lot
A litte
Not at all
3. Over the last week, how much has your skin interfered with you going
shopping
or looking after your
home
or
garden
?
Very much
A lot
A litte
Not at all
Not relevant
4. Over the last week, how much has your skin influenced the
clothes
you wear?
Very much
A lot
A litte
Not at all
Not relevant
5. Over the last week, how much has your skin affected any
social
or
leisure
activities?
Very much
A lot
A litte
Not at all
Not relevant
6. Over the last week, how much has your skin made it difficult for you to do any
sport
?
Very much
A lot
A litte
Not at all
Not relevant
7. Over the last week, has your skin prevented you from
working
or
studying
?
Yes
No
Not relevant
If
"No"
, over the last week, how much has your skin been a problem at
work
or
studfying
?
A lot
A litte
Not at all
8. Over the last week, how much has your skin created problems with your
partner
or any of your
close friends
or
relatives
?
Very much
A lot
A little
Not at all
Not relevant
9. Over the last week, how much of a problem has the
treatment
for your skin been, for example by making your home messy, or by taking up time?
Very much
A lot
A little
Not at all
Not relevant
Send
