There are four sections - Physical, Social, Mental, Emotional, please answer the questions in each section, and your ability score will be calculated from your answers. Plus an individual score for each section, as we recognise that peoples ability in different area's can differ a lot.

Bek - only tick one option for each question, or multiple responces allowed? how does that confuse the maths

Physical

1. How would you describe your current level of phsical health?
   • No symptoms
   • Mild Symptoms
   • Medium Symptoms
   • Severe Symptoms
   • Symptoms worsened by phyisical exertion
2. How would you describe you current level of activity
   • Fine - no ill effects
   • Exercise and Activity possible with careful pacing
   • some gentle exercise possible
   • exercise possible with assistance
   • no exercise possible
3. How often do you feel like you are in pain % of time
   • In pain - 0 - 20% of time.
   • In pain - 20 - 40% of time
   • In pain 40% - 60% of time
   • In pain 60 - 80% of time
   • In pain 80 - 100% of time
4. How severe is your pain most of the time?
   • Mild pain
   • Mild to Moderate Pain
   • Moderate Pain
   • Moderate to Severe Pain
   • Severe Pain
5. How tired do you feel (fatigue levels)
   • Fine
   • fatigued after exercise/ activity
   • tired some of the time whether active or not.
   • Tired alot of the time
   • Tired all of the time.

other question ideas

• Mobility

Social

1. Are you able to work or study?
   • Full time
   • Part time
   • Study/work at own pace
   • Study/work at home
   • No study/work

   Mental

   Emotional