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EQ-5D-3L English (UK)

(This question is mandatory)

Please select the ONE box that best describes your health TODAY.

MOBILITY

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© EuroQol Research Foundation. EQ-5D™ is a trade mark of the EuroQol Research Foundation. UK (English) v2.0
(This question is mandatory)

Please select the ONE box that best describes your health TODAY.

SELF-CARE

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© EuroQol Research Foundation. EQ-5D™ is a trade mark of the EuroQol Research Foundation. UK (English) v2.0
(This question is mandatory)

Please select the ONE box that best describes your health TODAY.

USUAL ACTIVITIES (e.g. work, study, housework, family or leisure activities)

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© EuroQol Research Foundation. EQ-5D™ is a trade mark of the EuroQol Research Foundation. UK (English) v2.0
(This question is mandatory)

Please select the ONE box that best describes your health TODAY.

PAIN / DISCOMFORT

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© EuroQol Research Foundation. EQ-5D™ is a trade mark of the EuroQol Research Foundation. UK (English) v2.0
(This question is mandatory)

Please select the ONE box that best describes your health TODAY.

ANXIETY / DEPRESSION

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© EuroQol Research Foundation. EQ-5D™ is a trade mark of the EuroQol Research Foundation. UK (English) v2.0
(This question is mandatory)

• We would like to know how good or bad your health is TODAY.

• This scale is numbered from 0 to 100.

•100 means the best health you can imagine.
   0 means the worst health you can imagine.

• Please indicate on the scale how your health is TODAY.

YOUR HEALTH
TODAY =

 
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© EuroQol Research Foundation. EQ-5D™ is a trade mark of the EuroQol Research Foundation. UK (English) v2.0
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