Did you discuss with your specialist how often you have to come back from this moment on?
Below you see a list of chronic conditions and diseases. Please indicate for each condition or disease whether you have it now or have had it in the past 12 months. Please answer this for each condition or disease.
Please indicate for each condition whether it interferes with your activities or not.
You have indicated that you have had trouble getting (additional) health insurance. What was the outcome?
You have indicated that you have had trouble getting life insurance. What was the outcome?
Symptoms or problems. Patients sometimes report that they have the following symptoms or problems. Please indicate the extent to which you have experienced these symptoms or problems during the past week. During the past week:
Symptoms or problems. Patients sometimes report that they have the following symptoms or problems. Please indicate the extent to which you have experienced these symptoms or problems during the past week. During the past 4 weeks: