36-Item Short Form Health Survey (SF-36)

In general, would you say your health is:

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

Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports

Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf

Lifting or carrying groceries

Climbing several flights of stairs

Climbing one flight of stairs

Bending, kneeling, or stooping

Walking more than a mile

Walking several blocks

Walking one block

Bathing or dressing yourself

Cut down on the amount of time you spent on work or other activities due to physical health

Accomplished less than you would like due to physical health

Were limited in the kind of work or other activities due to physical health

Had difficulty performing the work or other activities due to physical health

Cut down on the amount of time you spent on work or other activities due to emotional problems

Accomplished less than you would like due to emotional problems

Did not do work or other activities as carefully as usual due to emotional problems

Extent to which physical health or emotional problems interfered with normal social activities

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

How much did pain interfere with your normal work (including both work outside the home and housework)?

Did you feel full of pep?

Have you been a very nervous person?

Have you felt so down in the dumps that nothing could cheer you up?

Have you felt calm and peaceful?

Did you have a lot of energy?

Have you felt downhearted and blue?

Did you feel worn out?

Have you been a happy person?

Did you feel tired?

How much of the time has physical health or emotional problems interfered with your social activities?

I seem to get sick a little easier than other people

I am as healthy as anybody I know

I expect my health to get worse

My health is excellent