This form is a modified version of the WHOQOL (World Health Organization – Quality of Life) self-administration questionnaire. In general, this form aims to assess and evaluate how individuals perceived their quality of life. The factors involved in this measurement are individuals’ physical and psychological health, relations with others, and living condition. There are a total of 17 questions with five likert options in each. Due to the subjective nature of this form, there is no right and wrong answer for each question. Everyone can partake in the form by reflecting on their condition in the past two weeks. The approximate completion time for this form is five to ten minutes.
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