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SF-12
1. In general, would you say your health is:
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?
2. During a typical day, does your health now limit you in moderate activities such as moving a table,pushing a vacuum cleaner, bowling, or playing golf? If so, how much?
3. During a typical day, does your health now limit you in climbing several flights of stairs? If so, how much?
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?
4. During the past 4 weeks, have you accomplished less Ythan you would like with your work or other regular daily activities as a result of your physical health
5. During the past 4 weeks, were you limited in the kind of work or other activities as a result of your physical health?
6. During the past 4 weeks, have you accomplished less than you would like with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)?
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)?
7. During the past 4 weeks, did you do work oractivities less carefully than as a result of any emotional problems (such as feeling depressed or anxious)?
8. During the past 4 weeks, how much did pain interfere with your normal work (including work outside the home and housework)?
9. During the past 4 weeks, how much of the time have you felt calm & peaceful?
These questions are about how you have been feeling 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...
10. During the past 4 weeks, how much of the time did you have a lot of energy?
11. During the past 4 weeks, how much of the time have you felt down-hearted and blue?
12. 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.)?
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