Quality of Life Survey

Quality of Life Survey

The Importance of Research

Listed below are some statements that people may make about themselves. Please read the statements carefully and put a check in the box marked YES if the statement applies to you. Check the box marked NO if the statement does not apply to you.

Please answer every item. If you are not sure whether to answer YES or NO, check whichever answer you think is most true.

Developed by KIGS/KIMS Outcomes Research, Pharmacia Corp.

I have to struggle to finish things
I feel like I've got to sleep during the day
I feel lonely even when I am with other people
I have to read things several times before they sink in
It is hard for me to make friends
It takes a lot of effort for me to do even the simplest jobs
I have trouble controlling my emotions
I often lose my train of thought
I lack confidence
I've got to push myself to do things
I often feel very tense
I feel like I let people down
I find it hard to mix with people
I feel exhausted even when I haven't done anything
There are times when I feel very low
I avoid any responsibilities
I avoid socializing with people I don't know well
I feel like I'm a burden
I often forget what people say to me
I find it hard to plan ahead
I am easily irritated by people
I often feel too tired to do the things I have to do
I have to force myself to do everything that has to be done
I often have to force myself to stay awake
I have trouble remembering things

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