EQ-5D

NECST REGISTRY - EQ-5D QUALITY OF LIFE QUESTIONNAIRE
Is there a diagnosis of endometriosis?
NECST SUB ID
Unique ID
Welcome back,

Thank you for your continued participation and contribution to the NECST Registry and further understanding of the impact of endometriosis.

This is the EQ-5D quality of life questionnaire and is a standardised measure of health status. The EQ-5D was developed by the EuroQol Group to provide a simple, generic measure of health for clinical and economic appraisal.

Please complete the questionnaire below relating to your health status today.

If you have any questions or require assistance, please contact the NECST Network and Registry Team via email necst@unsw.edu.au or mobile 0451 472 238.
Please click the ONE box that best describes your health TODAY.
MOBILITY*
SELF-CARE*
USUAL ACTIVITIES (e.g. work, study, housework, family or leisure activities)*
PAIN / DISCOMFORT*
ANXIETY/ DEPRESSION*
We would like to know how good or bad your health is TODAY. This scale is numbered from 0 to 100. 100 means the best health you can imagine. 0 means the worst health you can imagine. Slide the box on the scale above to indicate how your health is TODAY. Now, please write the number you marked on the scale in the box below:*
Date completed*

DayMonthYear
Date
Thank you. This concludes this questionnaire. Please click "Submit" to submit your response.
© EuroQol Research Foundation. EQ-5D™ is a trade mark of the EuroQol Research Foundation
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NECST REGISTRY - EQ-5D QUALITY OF LIFE QUESTIONNAIRE