SF-36 Health Survey

This survey asks for your views about your health. This information will help you keep track of how you feel and how well you are able to do your usual activities.

Answer every question by selecting the answer as indicated. If you are unsure about how to answer a question, please give the best answer you can.

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1. In general, would you say your health is:

Excellent

Very Good

Good

Fair

Poor

2. Compared to one year ago, how would you rate your health in general now?

Much better now than one year ago

Somewhat better now than one year ago

About the same as one year ago

Somewhat worse now than one year ago

Much worse now than one year ago

3. The following questions are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much?

Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports	Yes, limited a lot	Yes, limited a little	No, not limited at all
Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf	Yes, limited a lot	Yes, limited a little	No, not limited at all
Lifting or carrying groceries	Yes, limited a lot	Yes, limited a little	No, not limited at all
Climbing several flights of stairs	Yes, limited a lot	Yes, limited a little	No, not limited at all
Climbing one flight of stairs	Yes, limited a lot	Yes, limited a little	No, not limited at all
Bending, kneeling, or stooping	Yes, limited a lot	Yes, limited a little	No, not limited at all
Walking more than a mile	Yes, limited a lot	Yes, limited a little	No, not limited at all
Walking several blocks	Yes, limited a lot	Yes, limited a little	No, not limited at all
Walking one block	Yes, limited a lot	Yes, limited a little	No, not limited at all
Bathing or dressing yourself	Yes, limited a lot	Yes, limited a little	No, not limited at all

4. During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of your physical health?

Cut down on the amount of time you spent on work or other activities	Yes	No
Accomplished less than you would like	Yes	No
Were limited in the kind of work or other activities	Yes	No
Had difficulty performing the work or other activities (for example, it took extra effort)	Yes	No

5. During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)?

Cut down on the amount of time you spent on work or other activities	Yes	No
Accomplished less than you would like	Yes	No
Did work or other activities less carefully than usual	Yes	No

6. During the past 4 weeks, to what extent has your physical health or emotional problems interfered with your normal social activities with family, friends, neighbors, or groups?

Not at all

Slightly

Moderately

Quite a bit

Extremely

7. How much bodily pain have you had during the past 4 weeks?

None

Very mild

Mild

Moderate

Severe

Very severe

8. During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)?

Not at all

Slightly

Moderately

Quite a bit

Extremely

9. These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling.

How much of the time during the past 4 weeks...

Did you feel full of pep?	All of the time	Most of the time	A good bit of the time	Some of the time	A little of the time	None of the time
Have you been a very nervous person?	All of the time	Most of the time	A good bit of the time	Some of the time	A little of the time	None of the time
Have you felt so down in the dumps that nothing could cheer you up?	All of the time	Most of the time	A good bit of the time	Some of the time	A little of the time	None of the time
Have you felt calm and peaceful?	All of the time	Most of the time	A good bit of the time	Some of the time	A little of the time	None of the time
Did you have a lot of energy?	All of the time	Most of the time	A good bit of the time	Some of the time	A little of the time	None of the time
Have you felt downhearted and blue?	All of the time	Most of the time	A good bit of the time	Some of the time	A little of the time	None of the time
Did you feel worn out?	All of the time	Most of the time	A good bit of the time	Some of the time	A little of the time	None of the time
Have you been a happy person?	All of the time	Most of the time	A good bit of the time	Some of the time	A little of the time	None of the time
Did you feel tired?	All of the time	Most of the time	A good bit of the time	Some of the time	A little of the time	None of the time

10. During the past 4 weeks, to what extent has your physical health or emotional problems interfered with your normal social activities with family, friends, neighbors, or groups?

All of the time

Most of the time

Some of the time

A little of the time

None of the time

11. How TRUE or FALSE is each of the following statements for you?

I seem to get sick a little easier than other people	Definitely true	Mostly true	Don't know	Mostly false	Definitely false
I am as healthy as anybody I know	Definitely true	Mostly true	Don't know	Mostly false	Definitely false
I expect my health to get worse	Definitely true	Mostly true	Don't know	Mostly false	Definitely false
My health is excellent	Definitely true	Mostly true	Don't know	Mostly false	Definitely false

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