SF-36v2™ Health Survey Scoring Demonstration


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.


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?

Yes,
limited
a lot

Yes,
limited
a little

No, not limited
at all

a

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

b

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

c

Lifting or carrying groceries

d

Climbing several flights of stairs

e

Climbing one flight of stairs

f

Bending, kneeling, or stooping

g

Walking more than a mile

h

Walking several hundred yards

i

Walking one hundred yards

j

Bathing or dressing yourself


4.

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

All
of the time

Most
of the time

Some
of the time

A little
of the time

None
of the time

a

Cut down on the amount of time you spent on work or other activities

b

Accomplished less than you would like

c

Were limited in the kind of work or other activities

d

Had difficulty performing the work or other activities (for example, it took extra effort)


5.

During the past 4 weeks, how much of the time 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)?

All
of the time

Most
of the time

Some
of the time

A little
of the time

None
of the time

a

Cut down on the amount of time you spent on work or other activities

b

Accomplished less than you would like

c

Did work or activities less carefully than usual


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

A little bit

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...

All
of the time

Most
of the time

Some
of the time

A little
of the time

None
of the time

a

Did you feel full of life?

b

Have you been very nervous?

c

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

d

Have you felt calm and peaceful?

e

Did you have a lot of energy?

f

Have you felt downhearted and depressed?

g

Did you feel worn out?

h

Have you been happy?

i

Did you feel tired?


10.

During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting friends, relatives, etc.)?

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?

Definitely
true

Mostly
true

Don't
know

Mostly
false

Definitely
false

A

I seem to get sick a little easier than other people

B

I am as healthy as anybody I know

C

I expect my health to get worse

D

My health is excellent

Thank you for completing these questions!