Do you have any long-standing physical or mental illness, or disability? By long-standing I mean anything that has troubled you over a period of at least 12 months or that is likely to affect you over a period of at least 12 months. Yes No Prefer not to say If yes, do any of these conditions or illnesses affect you in any of the following areas? Please tick the relevant box(es). Vision (e.g. blindness or partial sight) Hearing (e.g. deafness or partial hearing) Mobility (e.g. walking short distances or climbing stairs) Cognitive ability (e.g. dementia, brain injury, autism spectrum disorder) Mental health Other (please specify)_______________________________ None of the above Prefer not to say
Do you have any long-standing physical or mental illness, or disability? By long-standing I mean anything that has troubled you over a period of at least 12 months or that is likely to affect you over a period of at least 12 months. Yes No Prefer not to say If yes, do any of these conditions or illnesses affect you in any of the following areas? Please tick the relevant box(es). Vision (e.g. blindness or partial sight) Hearing (e.g. deafness or partial hearing) Mobility (e.g. walking short distances or climbing stairs) Cognitive ability (e.g. dementia, brain injury, autism spectrum disorder) Mental health Other (please specify)_______________________________ None of the above Prefer not to say
3-Brightlife-participant-entry-questionnaire-Large-Print-1.docx