SF-36 Health Survey Scoring Demonstration

Your Health and Well-Being

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

For each of the following questions, please select the one response that best describes your answer.

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

Yes No
a. Accomplished less than you would like
b. Accomplished less than you would like
c. Were limited in the kind of work or other activities
d. Accomplished less than you would like

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)?

Yes No
a. Accomplished less than you would like
b. Accomplished less than you would like
c. Did work or other 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 thetime A good bit of the time Some of the time A little of the time None of the time
a. Did you feel full of pep?
b. Have you been a very nervous person?
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 blue?
g. Did you feel worn out?
h. Have you been a happy person?
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

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