1. Do you feel nervous or on the edge due to your skin problems or any other factor, eg. during social interactions etc.(Required) Not at all Several days More than half the days Nearly every day This field is required.2. How often do you find yourself worrying uncontrollably. May be about your skin concerns, pimples, hair loss or family or wellbeing of loved ones etc.(Required) Not at all Several days More than half the days Nearly every day This field is required.3. How often do you feel down, hopeless or “depressed”. May be due to the way you look , feel or how someone treats you or for no apparent reason at all.(Required) Not at all Several days More than half the days Nearly every day This field is required.4. Do you feel you have little interest or pleasure in doing things which you would otherwise find interesting and enjoyable?(Required) Not at all Several days More than half the days Nearly every day This field is required.Name(Required) First Last This field is required.Phone Number(Required)This field is required.Email(Required) This field is required.Gender(Required) Male Female This field is required.CAPTCHAHiddenFirst two question scoreHiddenLast two question scoreHiddenTotal Score Back Submit