Combined GDS/GAS Pre Assessment

Are you basically satisfied with your life?

Yes No

Have you dropped many of your activities and interests?

Yes No

Do you feel that your life is empty?

Yes No

Do you often get bored?

Yes No

Are you in good spirits most of the time?

Yes No

Are you afraid something bad will happen?

Yes No

Do you feel happy most of the time?

Yes No

Do you often feel helpless?

Yes No

Do you prefer to stay at home?

Yes No

Do you feel you have more memory problems?

Yes No

Do you think it is wonderful to be alive now?

Yes No

Do you feel worthless?

Yes No

Do you feel full of energy?

Yes No

Do you feel hopeless?

Yes No

Do you think others are better off than you?

Yes No

Section C: Consent
DATA PRIVACY CONSENT
Art therapists are required to maintain a pictorial record of artwork produced during art therapy sessions. Typically, the art therapist takes a digital photograph of the artworks. Clients may retain the original upon request and if appropriate from the therapeutic perspective of the art therapist. This consent can be withdrawn at any time without explanation by contacting RPS. If you have any questions, we would be happy to discuss this further with you. Select ‘YES’ or ‘NO’ as appropriate.
Statement	YES	NO
I consent to my artworks being photographed.
I give consent for photographs and videos of my artworks and session information to be used for documentation and discussion during clinical supervision.
I consent to RPS highlighting my story of therapeutic change to raise awareness about art therapy for education purposes, such as research and conferences. All personal information will be kept confidential.
I understand that the creative arts therapist(s) will adhere to professional guidelines and will not disclose personal information without my explicit consent, except in cases where there is reason to believe that I or others may be at risk of actual or potential harm.
I consent to photographs and videos of me and my artworks being taken during the programme, and to these images being used for educational, publicity, and reporting purposes.
Consent Type Client Consent & Acknowledgement Caregiver / Guardian Consent (Under 21)
Informed Consent and Acknowledgement by Client I (NRIC last 4 digits: ), hereby confirm that I understand and consent to the above.
For Caregivers of Clients under 21 years old I (NRIC last 4 digits: ), am the parent / legal guardian of the client (NRIC last 4 digits: ), who is under 21 years old .

Combined GDS / GAS Pre Assessment

Assessment Information

Section A : GDS Questions

Section B : GAS Questions

Section C: Consent