EuroQol Group EQ-5D

EQ-5D-5L

Under each heading, please check the ONE box that

best describes your health TODAY

Name
Name
Date of Birth
Date of Birth
Please check the ONE LINE that best describes your health TODAY
Please check the ONE LINE that best describes your health TODAY
(e.g. work, study, housework, family or leisure activities) - Please check the ONE LINE that best describes your health TODAY
Please check the ONE LINE that best describes your health TODAY
Please check the ONE LINE that best describes your health TODAY
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. Now, please write the number you marked on the scale in the box below.