Research Questionnaire for amputees

Name
Gender
Age
Have you ever suffered from a mental health condition related to amputation such as
body dysmorphia or depression?
Y	N
If so could you please give details on how this has affected you?
What care, if any, did you receive for this/these condition(s)? Was this care offered or
did you have to seek it out yourself?
Do you think your psychological state influenced your physical recovery? If so in what way?
Do you feel that the aesthetic of your limb is important? If so in what way?
Y	N

Do you think involvement in the design of a new limb could help to give a better sense
of control?
Y	N
Do you think it is important for a prosthetic to match your aesthetic needs?
Y	N
Would you wear an aesthetically designed prosthetic or prosthetic cover? Please give
your reasons.
Y	N

 This information is for use in a paper on the psychological aspects of amputation and how aesthetics could play a part in recovery, you will remain anonymous. Please contact me if you have anything further to add or if you would be willing to have a more thorough conversation, or even if you’re just interested in what I’m doing.

 Thank you for completing this questionnaire.

Ross Reynolds,

Ross.C.Reynolds@hotmail.com