Health Opinion Survey (HOS) – 27 items

1.    Do you have any particular physical or health trouble at present? Yes‚ No‚ Undecided
2.    Do your hands ever tremble enough to bother you? Often‚ Sometimes‚ Never
3.    Are you ever troubled by your hands or feet sweating so that they feel damp and clammy? .. Often‚ Sometimes‚ Never
4.    Have you ever felt you were going to have a nervous breakdown? Often‚ Sometimes Never‚ Once or twice
5.    Have you ever been bothered by your heart beating hard? Often‚ Sometimes‚ Never
6.    Do you tend to feel tired in the mornings? Often‚ Sometimes‚ Never
7.    Do you have any trouble in getting to sleep and staying asleep? Often‚ Sometimes‚ Never
8.    How often are you bothered by ha‎ving an upset stomach?  Nearly all the time‚ Not very much‚ Pretty often Never
9.    Are you ever bothered by nightmares? (Dreams which frighten you or upset you?) Many times‚ A few times‚ Never
10.Do your arms or legs go to sleep rather easily? Often‚ Sometimes‚ Never
11.Have you ever been troubled by ‘cold sweats’? Often‚ A few times‚ Never
12.Do you feel you are bothered by all sorts (different kinds) of ailments in different parts of your body? Often‚ Sometimes‚ Never
13.Do you smoke? A lot‚ Some‚ Not at all
14.Are you troubled by sick headaches? Often‚ Sometimes‚ Never
15.Do you ever have loss of appetite? Often‚ Sometimes‚ Never
16.Do you ever have a bad taste in your mouth? Often‚ Sometimes‚ Never
17.Does your food ever seem tasteless and hard to swallow? Often‚ Sometimes‚ Never
18.Do you feel it is necessary to take vitamin pills for your health? Often‚ Sometimes‚ Never
19.Do you depend on patent medicines? Often‚ Sometimes‚ Never
20.Do you feel that you are more apt to catch contagious diseases than most people? Yes‚ No‚ Undecided
21.Has ill health affected the amount of work you do? Often‚ Sometimes‚ Never
22.Do you ever take weak turns? Often‚ Sometimes‚ Never
23.Have you ever had spells of dizziness? Often‚ Sometimes‚ Never
24.Do you tend to lose weight when you have important things bothering you? Often‚ Sometimes‚ Never
25.Are you bothered by nervousness? Often‚ Sometimes‚ Never
26.Have you ever been bothered by shortness of breath when you were not exercising or working hard? Often‚ Sometimes‚ Never
27.For the most part‚ do you feel healthy enough to carry out the things that you would like to do? Often‚ Sometimes‚ Never
 
 
Scoring:
No‚ Never‚ Not at all (0)
Sometimes‚ Undecided (1)
Yes‚ Often‚ A lot (2) “Except in the two four-point questions‚ nos. 4 and 8”
Four-point questions:
Never (0)
Once or twice‚ Not very much (1)
Sometimes‚ Pretty often (2)
Often‚ Nearly all the time (3)
 
 

Semmence‚ A. M.‚ (1969).The health opinion survey A psychiatric screening instrument. Journal of the Royal College of General Practitioners‚ 18(89): 344–348.