Sf-36 Health Survey printable pdf download

Sf-36 Health Survey

Name:

Study number:

Date when completing form:

SF-36 Health Survey

INSTRUCTIONS: This survey asks 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.

Please answer every question by marking the answer as indicated. If you are unsure about how to answer a question,

please give the best answer you can.

When complete, please return the questionnaire in the envelope provided.

1. In general, would you say your health is:

(circle one)

Excellent

…………………………………………………………………………………..

Very good

………………………………………………………………………………….

Good

………………………………………………………………………………….

Fair

………………………………………………………………………………….

Poor

………………………………………………………………………………….

2. Compared to one year ago, how would you rate your health in general now?

(circle one)

Much better now than one year ago

……………………………………………………….

Somewhat better than one year ago

……………………………………………………….

About the same as one year ago

……………………………………………………….

Somewhat worse than one year ago

……………………………………………………….

Much worse now than one year ago

……………………………………………………….

Sf-36 Health Survey