HEALTH

RAND > RAND Health > Surveys > RAND Medical Outcomes Study > 36-Item Short Form Survey (SF-36) >

36-ItemShortFormSurveyInstrument
(SF-36)
RAND36-ItemHealthSurvey1.0QuestionnaireItems
Chooseoneoptionforeachquestionnaireitem.
1.Ingeneral,wouldyousayyourhealthis:
1-Excellent
2-Verygood
3-Good
4-Fair
5-Poor

2.Comparedtooneyearago,howwouldyourateyourhealthingeneralnow?
1-Muchbetternowthanoneyearago
2-Somewhatbetternowthanoneyearago
3-Aboutthesame
4-Somewhatworsenowthanoneyearago
5-Muchworsenowthanoneyearago

Thefollowingitemsareaboutactivitiesyoumightdoduringatypicalday.Doesyour
healthnowlimityouintheseactivities?Ifso,howmuch?

Yes,

Yes,

No,not

limiteda
lot

limiteda
little

limitedat
all

4.Moderateactivities,suchasmovingatable,pushinga
vacuumcleaner,bowling,orplayinggolf

5.Liftingorcarryinggroceries

6.Climbingseveralflightsofstairs

7.Climbingoneflightofstairs

8.Bending,kneeling,orstooping

9.Walkingmorethanamile

10.Walkingseveralblocks

11.Walkingoneblock

12.Bathingordressingyourself

3.Vigorousactivities,suchasrunning,liftingheavyobjects,
participatinginstrenuoussports

Duringthepast4weeks,haveyouhadanyofthefollowingproblemswithyourworkor
otherregulardailyactivitiesasaresultofyourphysicalhealth?

Yes

No

13.Cutdowntheamountoftimeyouspentonworkorotheractivities

14.Accomplishedlessthanyouwouldlike
15.Werelimitedinthekindofworkorotheractivities
16.Haddifficultyperformingtheworkorotheractivities(forexample,ittookextra
effort)

Duringthepast4weeks,haveyouhadanyofthefollowingproblemswithyourworkor
otherregulardailyactivitiesasaresultofanyemotionalproblems(suchasfeeling
depressedoranxious)?

Yes

No

17.Cutdowntheamountoftimeyouspentonworkorotheractivities

18.Accomplishedlessthanyouwouldlike

19.Didn'tdoworkorotheractivitiesascarefullyasusual

20.Duringthepast4weeks,towhatextenthasyourphysicalhealthoremotional
problemsinterferedwithyournormalsocialactivitieswithfamily,friends,neighbors,or
groups?
1-Notatall
2-Slightly
3-Moderately
4-Quiteabit
5-Extremely

21.Howmuchbodilypainhaveyouhadduringthepast4weeks?
1-None
2-Verymild
3-Mild
4-Moderate
5-Severe
6-Verysevere

22.Duringthepast4weeks,howmuchdidpaininterferewithyournormalwork
(includingbothworkoutsidethehomeandhousework)?
1-Notatall
2-Alittlebit
3-Moderately
4-Quiteabit
5-Extremely

Thesequestionsareabouthowyoufeelandhowthingshavebeenwithyouduringthe
past4weeks.Foreachquestion,pleasegivetheoneanswerthatcomesclosesttotheway
youhavebeenfeeling.
Howmuchofthetimeduringthepast4weeks...

Allof

Most

Agood

Some

Alittle

None

the
time

ofthe
time

bitofthe
time

ofthe
time

ofthe
time

ofthe
time

23.Didyoufeelfullofpep?

24.Haveyoubeenaverynervous

25.Haveyoufeltsodowninthe
dumpsthatnothingcouldcheeryou
up?

26.Haveyoufeltcalmandpeaceful?

27.Didyouhavealotofenergy?

28.Haveyoufeltdownheartedand
blue?

29.Didyoufeelwornout?

30.Haveyoubeenahappyperson?

31.Didyoufeeltired?

person?

32.Duringthepast4weeks,howmuchofthetimehasyourphysicalhealthoremotional
problemsinterferedwithyoursocialactivities(likevisitingwithfriends,relatives,etc.)?
1-Allofthetime
2-Mostofthetime
3-Someofthetime
4-Alittleofthetime
5-Noneofthetime

HowTRUEorFALSEiseachofthefollowingstatementsforyou.

Definitely
true

Mostly
true

Don't
know

Mostly
false

Definitely
false

34.IamashealthyasanybodyIknow

35.Iexpectmyhealthtogetworse

36.Myhealthisexcellent

33.Iseemtogetsickalittleeasierthan
otherpeople

ABOUT
TheRANDCorporationisaresearchorganizationthatdevelopssolutionstopublicpolicychallengestohelpmake
communitiesthroughouttheworldsaferandmoresecure,healthierandmoreprosperous.RANDisnonprofit,nonpartisan,
andcommittedtothepublicinterest.
1776MainStreet
SantaMonica,California90401-3208
RANDisaregisteredtrademark.Copyright1994-2016RANDCorporation.