No	Somewhat	Moderate	Mostly have	Entirely have
Do you have plenty of energy to cope with everyday life?	1	2	3	4	5
Are you satisfied with your appearance?	1	2	3	4	5
Do you have enough money?	1	2	3	4	5
Do you think that people who know you accept you?	1	2	3	4	5
In everyday life, is the information you need in place?	1	2	3	4	5
Do you have the opportunity to do leisure activities?	1	2	3	4	5
	Very poor	Poor	General	Good	Very good
How is your activity capability?	1	2	3	4	5