| In general… | Excellent | Very good | Good | Fair | Poor |
|---|---|---|---|---|---|
| H1. Would you say your health is……………… | |||||
| H2. Would you say your quality of life is……… | |||||
| H3. How would you rate your physical health? | |||||
| H4. How would you rate your mental health, including your mood and your ability to think?.….….….….….….….….….….….….….…. | |||||
| In general… | Excellent | Very good | Good | Fair | Poor |
| H5. How would you rate your satisfaction with your social activities and relationships? |