RAND SF-36-Item Health Survey
| 1. In general, would you say your health is: | |
| Excellent | 1 |
| Very good | 2 |
| Good | 3 |
| Fair | 4 |
| Poor | 5 |
| 2. Compared to one year ago, how would your rate your health in general now? | |
| Much better now than one year ago | 1 |
| Somewhat better now than one year ago | 2 |
| About the same | 3 |
| Somewhat worse now than one year ago | 4 |
| Much worse now than one year ago | 5 |
The following items are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much?
(Circle One Number on Each Line)
| Yes, Limited a Lot | Yes, Limited a Little | No, Not limited at All | |
3. Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports | [1] | [2] | [3] |
4. Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf | [1] | [2] | [3] |
| 5. Lifting or carrying groceries | [1] | [2] | [3] |
6. Climbing several flights of stairs | [1] | [2] | [3] |
| 7. Climbing one flight of stairs | [1] | [2] | [3] |
8. Bending, kneeling, or stooping | [1] | [2] | [3] |
| 9. Walking more than a mile | [1] | [2] | [3] |
| 10. Walking several blocks | [1] | [2] | [3] |
| 11. Walking one block | [1] | [2] | [3] |
12. Bathing or dressing yourself | [1] | [2] | [3] |
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?
(Circle One Number on Each Line)
| Yes | No | |
13. Cut down the amount of time you spent on work or other activities | 1 | 2 |
14. Accomplished less than you would like | 1 | 2 |
| 15. Were limited in the kind of work or other activities | 1 | 2 |
| 16. Had difficulty performing the work or other activities (for example, it took extra effort) | 1 | 2 |
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)?
(Circle One Number on Each Line)
Yes | No | |
17. Cut down the amount of time you spent on work or other activities | 1 | 2 |
| 18. Accomplished less than you would like | 1 | 2 |
| 19. Didn’t do work or other activities as carefully as usual | 1 | 2 |
20. 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?
(Circle One Number)
Not at all 1
Slightly 2
Moderately 3
Quite a bit 4
Extremely 5
21. How much bodily pain have you had during the past 4 weeks?
(Circle One Number)
None 1
Very mild 2
Mild 3
Moderate 4
Severe 5
Very severe 6
22. During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)?
(Circle One Number)
Not at all 1
A little bit 2
Moderately 3
Quite a bit 4
Extremely 5
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 . . .
(Circle One Number on Each Line)
| 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 | |
| 23. Did you feel full of pep? | 1 | 2 | 3 | 4 | 5 | 6 |
| 24. Have you been a very nervous person? | 1 | 2 | 3 | 4 | 5 | 6 |
| 25. Have you felt so down in the dumps that nothing could cheer you up? | 1 | 2 | 3 | 4 | 5 | 6 |
| 26. Have you felt calm and peaceful? | 1 | 2 | 3 | 4 | 5 | 6 |
| 27. Did you have a lot of energy? | 1 | 2 | 3 | 4 | 5 | 6 |
| 28. Have you felt downhearted and blue? | 1 | 2 | 3 | 4 | 5 | 6 |
| 29. Did you feel worn out? | 1 | 2 | 3 | 4 | 5 | 6 |
| 30. Have you been a happy person? | 1 | 2 | 3 | 4 | 5 | 6 |
| 31. Did you feel tired? | 1 | 2 | 3 | 4 | 5 | 6 |
32. During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting with friends, relatives, etc.)?
(Circle One Number)
All of the time 1
Most of the time 2
Some of the time 3
A little of the time 4
None of the time 5
How TRUE or FALSE is each of the following statements for you.
(Circle One Number on Each Line)
| Definitely True | Mostly True | Don’t Know | Mostly False | Definitely False | |
| 33. I seem to get sick a little easier than other people | 1 | 2 | 3 | 4 | 5 |
| 34. I am as healthy as anybody I know | 1 | 2 | 3 | 4 | 5 |
| 35. I expect my health to get worse | 1 | 2 | 3 | 4 | 5 |
| 36. My health is excellent | 1 | 2 | 3 | 4 | 5 |