1. In general, would you say your health is:
Excellent
2. the kinds or amounts of vigorous activities you can do, like lifting heavy objects, running or participating in strenuous sports
Not limited at all
3. the kinds or amounts of moderate activities you can do, like moving a table, carrying groceries, or bowling
Not limited at all
4. Walking uphill or climbing a few flights of stairs
Not limited at all
5. Bending, lifting, or stooping
Not limited at all
6. Walking one block
Not limited at all
7. Eating, dressing, bathing, or using the toilet
Not limited at all
8. How much bodily pain have you had during the past 4 weeks:
None
9. Does your health keep you from working at a job, doing work around the house, or going to school?
No
10. Have you been unable to do certain kinds or amounts of work, housework, or schoolwork because of your health?
No
11. How much of the time, during the past month, has you health limited your social activities (like visiting with friends or close relatives)?
None of the time
12. How much of the time, during the past month, have you been a very nervous person?
None of the time
13. During the past month, how much of the time have you felt calm and peaceful?
All of the time
14. How much of the time, during the past month, have you felt downhearted and blue?
None of the time
15. During the past month, how much of the time have you been a happy person?
All of the time
16. How often, during the past month, have you felt so down in the dumps that nothing could cheer you up?
None of the time
17. I am somewhat ill
Definitely false
18. I am as healthy as anybody I know
Definitely true
19. My health is excellent
Definitely true
20. I have been feeling bad lately
Definitely false
20-Item Short Form Survey (SF-20)
Choose one option for each questionnaire item.
1. In general, would you say your health is:
Activities
For how long (if at all) has your health limited you in each of the following activities?
2. the kinds or amounts of vigorous activities you can do, like lifting heavy objects, running or participating in strenuous sports
3. the kinds or amounts of moderate activities you can do, like moving a table, carrying groceries, or bowling
4. Walking uphill or climbing a few flights of stairs
5. Bending, lifting, or stooping
6. Walking one block
7. Eating, dressing, bathing, or using the toilet
8. How much bodily pain have you had during the past 4 weeks:
9. Does your health keep you from working at a job, doing work around the house, or going to school?
10. Have you been unable to do certain kinds or amounts of work, housework, or schoolwork because of your health?
Fellings
For each of the following questions, please mark the one answer that comes closest to the way you have been feeling during the past month.
11. How much of the time, during the past month, has you health limited your social activities (like visiting with friends or close relatives)?
12. How much of the time, during the past month, have you been a very nervous person?
13. During the past month, how much of the time have you felt calm and peaceful?
14. How much of the time, during the past month, have you felt downhearted and blue?
15. During the past month, how much of the time have you been a happy person?
16. How often, during the past month, have you felt so down in the dumps that nothing could cheer you up?
Please mark what best describes whether each of the following statements is true or false for you.
17. I am somewhat ill
18. I am as healthy as anybody I know
19. My health is excellent
20. I have been feeling bad lately