Quality of Life Wound Checklist




A wound (or cut, injury, ulcer) is a break to the skin that may be taking some time to heal. Please answer these questions about how you are coping with your wound.

Question image
YesSometimesNo
Question image
YesSometimesNo
Question image
YesSometimesNo
Question image
YesSometimesNo
Question image
YesSometimesNo
Question image
YesSometimesNo
7. Please press the picture to indicate whether you sleep in a bed or a chair.

8. Please select a number to show how your pain has been recently.

0 = No Pain. 10 = Worst pain.


Question image
Question image

11. How do you rate your overall quality of life?

Please select the number to show your answer
0 = worst quality of life 100 = best quality of life