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EQ-5D-5L health questionnaire (age 16+)

Thank you for taking the time to complete this survey. It is part of the evaluation for the South East London Enhanced Sickle Cell Community Service and should take no more than five minutes to complete. You will be asked questions about your health today.

This survey covers five dimensions of health: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. You will be asked to rate the severity of each dimension. Please answer honestly.

We would like to follow up with you in 4–6 months to repeat the survey. Completing both surveys will help us assess whether the Enhanced Sickle Cell Community Service is having a positive impact on the quality of life within the sickle cell community. To allow us to contact you for the follow-up survey, please provide your email address in the survey.

Confidentiality: All responses will be kept confidential and used solely for the stated purposes. All recorded responses and published data will be anonymized, and no personally identifiable information will be shared.

To learn more about this survey, visit the EQ-5D-5L website. If you have any questions, please contact gst-tr.selsicklecommunity@nhs.net.

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Contact details

By providing your name and email address below, you are giving consent for us to contact you in 4-6 months to ask you to complete this survey again. This will allow us to evaluate the community service that you have accessed so that we can continue providing enhanced community services to the sickle cell community in south east London. 

Your email address will not be used for any other communications.

Maximum 255 characters

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Appointment questions

The following questions are about the appointment you are attending TODAY.

3.  

Which team are you seeing at your appointment today?

* required
4.  

If you are seeing the multi-disciplinary team (MDT), which member/s of the team are you seeing today?

5.  

Have you had any support from the sickle cell community team in the past 6 months?

* required
6.  

Is this the first time you've filled out this survey?

* required