In general, how would you rate your health?
The following questions ask about activities you might do during a typical day. Does your health now limit you in these activities?
Vigorous activities, such as running, lifting heavy objects, or (if you wanted to) your ability to participate in strenuous sports.
Moderate activities, such as cleaning the house, lifting a chair, playing golf or swimming.
Lifting or carrying bags of shopping.
Climbing a steep hill.
Climbing one flight of stairs.
Getting up from a sitting position.
Walking more than a kilometer.
Walking one hundred meters.
Showering or dressing yourself.
To what extent has your physical health or emotional problems interfered with your normal social activities with family, friends, neighbors or social groups?
These questions are about how you feel during the past month. For each question, please give the one answer that comes closest. How much of the time during the past 4 weeks:
Did your feet get tired?
Did you have a lot of energy?
Did your feet feel worn out?
Did you feel full of life?
During the past 4 weeks, how much of the time has your emotional problems or physical health interfered with your social activities (like visiting with friends, relatives, etc.)?
How true or false is each of the following statements for you?
I seem to get sick a little easier than other people.
I am as healthy as anybody I know.
I expect my health to get worse.
My health is excellent
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