1. How would you rate your quality of life?
2. How satisfied are you with your health?
Neither satisfied nor dissatisfied
3.
The following questions ask about how much you have experienced certain things in the last two weeks.
To what extent do you feel that (physical) pain prevents you from doing what you need to do?
4. How much do you need any medical treatment to function in your daily life?
5. How much do you enjoy life?
6. To what extent do you feel your life to be meaningful?
7. How well are you able to concentrate?
8. How safe do you feel in your daily life?
9. How healthy is your physical environment?
10.
The following questions ask about how completely you experience or were able to do certain things in the last two weeks.
Do you have enough energy for everyday life?
11. Are you able to accept your bodily appearance?
12. Have you enough money to meet your needs?
13. How available to you is the information that you need in your day-to-day life?
14. To what extent do you have the opportunity for leisure activities?
15. How well are you able to get around?
16.
The following questions ask you to say how good or satisfied you have felt about various aspects of your life over the last two weeks.
How satisfied are you with your sleep?
Neither satisfied nor dissatisfied
17. How satisfied are you with your ability to perform your daily living activities?
Neither satisfied nor dissatisfied
18. How satisfied are you with your capacity for work?
Neither satisfied nor dissatisfied
19. How satisfied are you with yourself?
Neither satisfied nor dissatisfied
20. How satisfied are you with your personal relationships?
Neither satisfied nor dissatisfied
21. How satisfied are you with your sex life?
Neither satisfied nor dissatisfied
22. How satisfied are you with the support you get from your friends?
Neither satisfied nor dissatisfied
23. How satisfied are you with the conditions of your living place?
Neither satisfied nor dissatisfied
24. How satisfied are you with your access to health services?
Neither satisfied nor dissatisfied
25. How satisfied are you with your transport?
Neither satisfied nor dissatisfied
26.
The following question refers to how often you have felt or experienced certain things in the last two weeks.
How often do you have negative feelings such as blue mood, despair, anxiety, depression?