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EQ - 5D - Health questionaire
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Name
Your answer
Age - range
17 - 25
25 - 35
35 - 45
45 - 55
55 -65
65 +
Other:
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Post code
Your answer
Ethnic background
White British
Irish British
Other white background
MIXED - WHITE & BLACK CARIBBEAN 4
MIXED - WHITE & BLACK AFRICAN
ANY OTHER MIXED / MULTIPLE ETHNIC BACKGROUND
ASIAN.- ASIAN BRITISH- INDIAN
PAKISTANI
BANGLADESHI
CHINESE
ANY OTHER BACKGROUND
BLACK/AFRICAN/CARIBBEAN/BLACK BRITISH
AFRICAN
CARIBBEAN
ANY OTHER BLACK / AFRICAN / CARIBBEAN
OTHER ETHNIC GROUP - ARAB
ANY OTHER ETHNIC GROUP
Other:
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