The Children’s Dermatology Life Quality Index (CDLQI)

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The Children’s Dermatology Life Quality Index (CDLQI)

The Children’s Dermatology Life Quality Index (CDLQI) is a validated questionnaire used to measure how a skin condition affects a child’s quality of life, including symptoms, daily activities, school, relationships, sleep, and emotional wellbeing.

Hospital No.

Diagnosis

Name

First Last

Email

Age

Date

DD slash MM slash YYYY

Address

Street Address City State Postal Code

The aim of this questionnaire is to measure how much your skin problem has affected you OVER THE LAST WEEK.

Over the last week, how itchy, “scratchy”, sore or painful has your skin been?(Required)

Very much

Quite a lot

Only a little

Not at all

Over the last week, how embarrassed or self conscious, upset or sad have you been because of your skin?(Required)

Very much

Quite a lot

Only a little

Not at all

Over the last week, how much has your skin affected your friendships?(Required)

Very much

Quite a lot

Only a little

Not at all

Over the last week, how much have you changed or worn different or special clothes/shoes because of your skin?(Required)

Very much

Quite a lot

Only a little

Not at all

Over the last week, how much has your skin trouble affected going out, playing, or doing hobbies?(Required)

Very much

Quite a lot

Only a little

Not at all

Last week, was it school time or holiday time?(Required)

School time

Holiday time

If school time: Over the last week, how much did your skin problem affect your school work?(Required)

Prevented school

Very much

Quite a lot

Only a little

Not at all

If holiday time: How much over the last week, has your skin problem interfered with your enjoyment of the holiday?(Required)

Very much

Quite a lot

Only a little

Not at all

Over the last week, how much trouble have you had because of your skin with other people calling you names, teasing, bullying, asking questions or avoiding you?(Required)

Very much

Quite a lot

Only a little

Not at all

Over the last week, how much has your sleep been affected by your skin problem?(Required)

Very much

Quite a lot

Only a little

Not at all

Over the last week, how much of a problem has the treatment for your skin been?(Required)

Very much

Quite a lot

Only a little

Not at all

CDLQI Score:

Δ

About Us

Providing trusted dermatological services since 1999 – offering the latest medical, surgical and cosmetic treatments using scientifically based methods to achieve the safest, most outstanding results.

Skindoc respectfully acknowledges the traditional owners and custodians of our country through Australia and their continuing connection to the land, waters and community.

We pay our respects to the Aboriginal and Torres Strait Islander People, their cultures and to Elders past and present.

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21 Castlereagh St (corner Campbell Street) Liverpool NSW, 2170
9602 5785
info@skindoc.com.au