Common use of Excellent Very Good Good Fair Poor Clause in Contracts

Excellent Very Good Good Fair Poor. Now thinking about your physical health, which includes physical illness and injury, for how any days during the past 30 days was your physical health not good? Number of Days: (0-30 days) Now thinking about your mental health which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good? Number of Days: (0-30 days) During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreations? Number of Days: (0-30 days) Who is answering this form? (Circle One) Parent/Guardian Child