Accepting new patientsTexas residents onlyWe do not accept MedicaidNow open: North Dallas office
Online patient form

WHODAS 2.0

Fields marked * are required. Your answers are sent securely to our intake team — nothing is stored in your browser.

This questionnaire asks about difficulties due to health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs.

Think back over the past 30 days and answer these questions, thinking about how much difficulty you had doing the following activities. For each question, please circle only one response.

In the past 30 days, how much difficulty did you have in:
S1 Standing for long periods such as 30 minutes?
S2 Taking care of your household responsibilities?
S3 Learning a new task, for example, learning how to get to a new place?
S4 How much of a problem did you have joining in community activities (for example, festivities, religious or other activities) in the same way as anyone else can?
S5 How much have you been emotionally affected by your health problems?
S6 Concentrating on doing something for ten minutes?
S7 Walking a long distance such as a kilometre [or equivalent]?
S8 Washing your whole body?
S9 Getting dressed?
S10 Dealing with people you do not know?
S11 Maintaining a friendship?
S12 Your day-to-day work?

Your submission is emailed securely to our intake team. This form is not for emergencies.

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