Ninewells Hospital & Medical School, Dundee, DD1 9SY


The EQ-5D is a self-report measure of health status. It also includes a 'visual analogue' scale, so that the individual can rate their health from a 0 (worst) to 100 (best) state.


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Your unique ID that will have been given to you before being asked to fill in this form. Please get in touch if you can't remember it.
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By selecting one box/ circle from each group below, please indicate which statement best describes your health state today.
Usual activities (e.g. work, study, housework, family, or leisure activities)
Pain/ Discomfort
Anxiety/ Depression
To help people say how good or bad a health state is, we have drawn a scale (rather like a thermometer) on which the best state you can imagine is marked 100 and the worst state you can imagine is marked by 0.
We would like you to indicate on this scale how good or bad your own health is today, in your opinion. Please do this by using the slider below to indicate how good or bad your health state is.
Selected Value: 0
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