This questionnaire asks how you feel about your quality of life, health, or other areas of your life. Please answer all the questions. If you are unsure about which response to give to a question, please choose the one that appears most appropriate. This can often be your first response. Please read each question, assess your feelings, and circle the number on the scale that gives the best answer for you for each question.
How would you rate your quality of life?
How satisfied are you with your health?
To what extent do you feel that physical pain prevents you from doing what you need to do?
How much do you need any medical treatment to function in your daily life?
How much do you enjoy life?
To what extent do you feel your life to be meaningful?
How well are you able to concentrate?
How safe do you feel in your daily life?
How healthy is your physical environment?
Do you have enough energy for everyday life?
Are you able to accept your bodily appearance?
Have you enough money to meet your needs?
How available to you is the information that you need in your day-to-day life?
To what extent do you have the opportunity for leisure activities?
How well are you able to get around?
How satisfied are you with your sleep?
How satisfied are you with your ability to perform your daily living activities?
How satisfied are you with your capacity for work?
How satisfied are you with yourself?
How satisfied are you with your personal relationships?
How satisfied are you with your sex life?
How satisfied are you with the support you get from your friends?
How satisfied are you with the conditions of your living place?
How satisfied are you with your access to health services?
How satisfied are you with your mode of transportation?
How often do you have negative feelings, such as blue mood, despair, anxiety, depression?
