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FIRST NAME

Ansa

LAST NAME

Siddique

Assessment Completed

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CLIENT PROFILE

PROGRAMME DETAILS

CLIENT PROFILE

PROGRAMME DETAILS

ASSESSMENT FORMS

ASSESSMENT FORMS

Anchor 1

Contact Details

DATE OF BIRTH:

​

PHONE:

01706523113 07936534826

EMAIL:

kwhc@gmail.com

ADDRESS:

​

38

Albion Street

Rochdale

OL11 4HQ

Referral Details

ORGANISATION:

Rochdale District & Mind

CONTACT:

Uzma Firdos

Client Notes

Needs Of The Client (From referral)

Ansa is a carer for her mother in law, she would benefit from holistic therapy to continue to care for her. Carer is a mother of four girls ans can feel stressed and tense due to her lack of support as a carer and mother.

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Additional Notes (From KWH)

Availability Information

Yes

No

Does the client need to start services immediately?

Therapy Details

Does the client require holistic therapies?

Yes

No

Counselling Details

Yes

No

Does the client require counselling services?

WARNING!

Clicking "I'M SURE" below will save all your answers in this assessment. You will not be able to make changes without contacting Admin/Support

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I'M SURE

STATEMENT

No

Well-being Assessment Form

Client has Dementia -

SWEMWBS

STATEMENT

No

NONE OF THE TIME

SOME OF THE TIME 

ALL OF THE TIME 

RARELY

OFTEN

1.

I've been feeling optimistic about the future

2.

I've been feeling useful

3.

I've been feeling relaxed

4

I've been dealing with problems well

5

I've been thinking clearly

6

I've been feeling close to other people

7

I've been able to make up my own mind about things

INITIAL SCORE:

40

WELL-BEING INDICATOR:

ABOVE AVERAGE

Well-being scale:

0 - 21 = Low   |   22- 24 = Below Average   |   25 - 26 =  Average   |   27 - 35 = Excellent

Short version of the "Warwick-Edinburgh Mental Well-being Scale" (SWEMWBS) @NHS Scotland, University of Warwick and University of Edinburgh 2006 all rights reserved

ONSSWQ

NOT AT ALL

EXTREMELY 

1

How satisfied are you with your life nowadays?

2

How happy did you feel yesterday?

3

How anxious did you feel yesterday?

4

Do you feel that the things you do are worthwhile?

The Office of National Statistics' subjective well-being questions (ONSSWQ). All rights reserved

SOCIAL TRUST

MOST PEOPLE

CAN BE TRUSTED

CAN'T BE

TOO CAREFUL

No

STATEMENT

1

Would you say that people can be trusted?

The New Economic Foundation's social trust question (NEFST). All rights reserved

KWWBS

STATEMENT

No

DISAGREE

AGREE

1

Overall, I have a great sleep: pattern

2

I, mostly, have a great range of motion:

3

Most of the time, I don't feel tense 

4

Generally, I don't feel physically drained

Developed at Kenny Webber by adapting established principles and techniques from research into the physical aspects of mental health.

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SOME FIELDS ARE MISSING ABOVE. PLEASE CHECK YOUR ANSWERS AND TRY AGAIN

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