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Summary:

During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting with friends, relatives, etc)?

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Below are a number of statements that people often use to describe themselves. Please read each statement and then circle the appropriate number next to that statement to indicate your answer. There are no right or wrong answers. Your own impression is the only thing thing that matters.

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For the following questions, please circle the number that best corresponds to your views.

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I still enjoy the things I used to enjoy

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I get a sort of frightened feeling as if something awful is about to happen

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To improve healthcare, we would like to know what information you received about the various aspects of your illness and its treatment. Please answer all the questions yourself by choosing the answer that best applies to you. There are no right or wrong answers.

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During your current disease or treatment, how much information have you received on:

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Have you received written information?

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Have you received information on CD or tape / video?

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Were you satisfied with the amount of information you received?

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Do you wish to receive more information?

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Do you wish that you had received less information?

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Overall has the information you have received been helpful?

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Do you use the internet?

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I can enjoy a good book or radio or TV program

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I get sudden feelings of panic

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I can laugh and see the funny side of things

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Worrying thoughts go through my mind

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I feel cheerful

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I can sit at ease and feel relaxed

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