QOLIE-31

QOLIE-31







    PLEASE ENSURE TO ANSWER ALL QUESTIONS.


    The following questions are about how you FEEL and how things have been for you during the past 4 weeks. Please choose the answer that most applies to you and the way you have been feeling.

    How much of the time during the past 4 weeks…














    The following questions are about MEMORY



    The following questions are about CONCENTRATION problems you may have had in the last 4 weeks.



    The following questions are about problems you may have with certain ACTIVITIES in the past 4 weeks. Please tell us how much your epilepsy or anti-epileptic medication has caused trouble with…



    The following questions relate to the way you FEEL about your Seizures





    For each of these problems, please rate how much they bother you on a scale of 1 to 5.

    1 = Not at all bothersome
    5= Extremely bothersome







    How good or bad do you think your health is?

    0 = worst imaginable state
    100 = best imaginable state

    THANK YOU FOR COMPLETING THIS QUESTIONNAIRE.

    STAFF USE ONLY
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