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IEQ Questionnaire


When injuries happen, they can have profound effects on our lives. This scale was designed to assess how your injury has affected your life.

Listed below are twelve statements describing different thoughts and feelings that you may experience when you think about your injury.

Using the following scale, please indicate how frequently you experience these thoughts and feelings when you think about your injury.
Name*
NeverRarelySometimesOftenAll the time
NeverRarelySometimesOftenAll the time
NeverRarelySometimesOftenAll the time
NeverRarelySometimesOftenAll the time
NeverRarelySometimesOftenAll the time
NeverRarelySometimesOftenAll the time
NeverRarelySometimesOftenAll the time
NeverRarelySometimesOftenAll the time
NeverRarelySometimesOftenAll the time
NeverRarelySometimesOftenAll the time
NeverRarelySometimesOftenAll the time
NeverRarelySometimesOftenAll the time
Consent*
This field is for validation purposes and should be left unchanged.