Questionnaire Text

Questionnaire form view entire document: text image

A. General characteristics

2. How old are you in years completed?

(For those over 99 years write 99)
____

Questionnaire instructions view entire document: text image

2. How old are you in years completed?
"00" is recorded in the line provided for those younger than one year of age; "99" is recorded for those older than 99 years of age.