PSORIASIS Dermatology Life Quality Index (DLQI) and Early Psoriatic Arthritis Screening Questionnaire (EARP) *This form is only to be completed exclusively by Skin Health Institute patients before their telehealth appointment. Please enable JavaScript in your browser to complete this form.Patient Name *FirstLastDateThe aim of this questionnare is to measure how much your skin problem has affected your life OVER THE LAST WEEK. Please tick one box for each question. 1. Over the last week, how itchy, sore, painful or stinging has your skin been?Very muchA lotA littleNot at all2. Over the last week, how embarrassed or self-conscious have you been because of your skin?Very muchA lotA littleNot at all3. Over the last week, how much has your skin interfered with you going shopping or looking after your home or garden?Very muchA lotA littleNot at allNot relevant4. Over the last week, how much has your skin influenced the clothes you wear?Very muchA lotA littleNot at allNot relevant5. Over the last week, how much has your skin affected any social or leisure activities?Very muchA lotA littleNot at allNot relevant6. Over the last week, how much has your skin made it difficult for you to do any sport?Very muchA lotA littleNot at allNot relevant7a. Over the last week, has your skin prevented you from working or studying?YesNoNot relevant7b. If you selected 'No' to the above question, over the last week, how much has your skin been a problem at work or studying?Very muchA lotA littleNot at all8. Over the last week, how much has your skin created problems with your partner or any of your close friends or relatives?Very muchA lotA littleNot at allNot relevant9. Over the last week, how much has your skin caused any sexual difficulties?Very muchA lotA littleNot at allNot relevant10. Over the last week, how much of a problem has the treatment for your skin been, for example, by making your home messy or taking up time?Very muchA lotA littleNot at allNot relevantEarly Psoriatic Arthritis Screening Questionnaire (EARP) Please select Yes or No for the following questions. 1. Do your joints hurt?YesNo2. Have you taken an anti-inflammatory medication more than twice a week for joint pain in the last 3 months?YesNo3. Do you wake up at night because of low back pain?YesNo4. Do you feel stillness in your hands for more than 30 minutes in the morning?YesNo5. Do your wrists and fingers hurt?YesNo6. Do your wrists and fingers swell?YesNo7. Does one finger hurt and swell for more than 3 days?YesNo8. Does your Achilles tendon swell?YesNo9. Do your feet and ankles hurt?YesNo10. Do your elbows or hips hurt?YesNoSubmit
