General Health and Welfare Questionnaire for over 65 yr olds

General Health and Welfare Questionnaire for over 65 yr olds

This questionnaire helps it's to understand how well you are managing day-to-day activities and whether you maybe living with frailty. Frailty is not simply a result of ageing; it describes how health problems can affect your strength , energy, mobility and independence. Please answer the questions based on your usual health and abilities over the past few months, rather than how you feel on a particularly good or bad day. There are no right and wrong answers, and your responses help us organise our community services and tailor the most appropriate care and support for you.

Personal Details







Please detail any communication difficulties


Personal care and level of activity






Hearing and eye sight



Next of Kin Details

Please provide the Next of Kin  and Power Of Attorney Details







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Page last reviewed: 06 November 2026
Page created: 01 November 2026