Bristol Activities of Daily Living Scale

Please use this date format: DD/MM/YYYY.
Any responses we send will go to this email address.
Please use this date format: DD/MM/YYYY.
This questionnaire is designed to reveal the everyday ability of people who have memory difficulties of one form or another.

For each activity (No. 1 - 20), statements a - e refer to a different level of ability.

Thinking of the last 2 weeks, tick the box that represents your relative's/friend's AVERAGE ability. (If in doubt about which box to tick, choose the level of ability which represents their average performance over the last 2 weeks. Tick 'Not applicable' if your relative never did that activity when they were well).