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UCLA Loneliness Scale

This scale comprises 3 questions that measure three dimensions of loneliness: relational connectedness, social connectedness, and self-perceived isolation. Please ask the resident/senior member the 3 following questions below. The resident should answer the questions with the response: 1 = Hardly Ever 2 = Some of the time 3 = Often

MM slash DD slash YYYY
Name of Volunteer(Required)
Name of Senior(Required)
1. How often do you feel that you lack companionship?(Required)
2. How often do you feel left out?(Required)
3. How often do you feel isolated from others?(Required)