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EDS Questionnaire

Birthday
Day
Month
Year

Do you have any of the following:

Unusually soft or velvety skin
Yes
No
Mild skin hyperextensibility
Yes
No
Unexplained striae at the back, groins, thighs, breasts and/or abdomen
Yes
No
Bilateral piezogenic papules of the heel
Yes
No
Recurrent or multiple abdominal hernia(s)
Yes
No
Atrophic scarring involving at least two sites
Yes
No
Pelvic floor, rectal and/or uterine prolapse
Yes
No
Dental crowding and high or narrow palate
Yes
No
Arachnodactyly (very long fingers)
Yes
No
Arm span-to-height ratio ≥1.05
Yes
No
Mitral valve prolapse (MVP)
Yes
No
Aortic root dilatation
Yes
No
Positive family history of hypermobile Ehler Danlos Syndrome
Yes
No
Musculoskeletal pain in two or more limbs, recurring daily for at least 3 months
Yes
No
Chronic, widespread pain for ≥3 months
Yes
No
Recurrent joint dislocations, subluxations or joint instability, in the absence of trauma
Yes
No

Do you or have you suffered from any of the following:

(some questions may be repeated from above but please answer)

Poor wound healing or skin that is fragile and has been difficult to suture
Yes
No
Severe scoliosis at an early age
Yes
No
Club foot, foot or hand deformities
Yes
No
Muscle weakness
Yes
No
Arterial dissection or aneurysms
Yes
No
Early-onset varicose veins
Yes
No
Organ rupture
Yes
No
Eye conditions such as lens dislocation, retinaal detachment, or required eye surgery
Yes
No
Recurrent hernias
Yes
No
Recurrent spontaneous pneumothoraces
Yes
No
Severe early-onset periodontitis
Yes
No

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