Domestic activities

by | 23 May 2021

Domestic activities

Choose one of the listed activities (or other) that you would like to be able to do, with or without pain.

For example – vacuuming:

Choose vacumming and choose current ability – if you can only do 20% of what you would like to be able to do, choose a 1 as your current ability.

Domestic activities

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DD slash MM slash YYYY
Please choose from one of the following activities(Required)

Please indicate your current ability to perform this activity(Required)
0 = unable to perform any of this activity, 10 = able to completely perform activity