WHODAS - eSignature
This questionnaire asks about difficulties due to health conditions. Health conditions include diseases or
illnesses, other health problems that may be short or long-lasting, injuries, mental or emotional problems,
and problems with alcohol or drugs.
Think back over the past 30 days and answer these questions, thinking about how much difficulty you
had done the following activities. For each question, please circle only one response.
In the past 30 days, how much difficulty did you have in:
Leave this empty:
Your legal name
Your email address
If you have questions about the contents of this document, you can email the document owner.
Document Name: WHODAS - eSignature
Agree & Sign