Penny Brohn UK

Help change life with cancer. For good

MYCaW – GenesisCare – First Form

meaningful-measures

Genesis Care MYCaW 1

Please tick the relevant boxes below so we can understand more about the data collection:

I am a: (please select) *
This was completed: (please tick) *

Please write down one or two concerns or problems which you would most like us to help you with.

Please rate to show how severe each concern or problem is now:
This should be YOUR opinion, no-one else's!

Concern or problem 1
(0 = Not bothering me at all and 6 = Bothers me greatly) *
Concern or problem 2
(0 = Not bothering me at all and 6 = Bothers me greatly)

How would you rate your general feeling of wellbeing now? (How do you feel in yourself?)

Wellbeing
(0 = As good as it could be and 6 = As bad as it could be) *

Measure Yourself Concerns and Wellbeing 2020 © Meaningful Measures Ltd

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