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Free online Short Form-36 Health Survey (SF-36)

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Welcome to your Short Form-36 Health Questionnaire Survey (SF-36) The SF-36 is an indicator of overall health status. This survey is validated.

The Short Form-36 Health Questionnaire Survey (SF-36) is a widely used instrument for measuring patient-reported health status. It consists of 36 questions that assess eight domains of health, including physical functioning, role limitations due to physical health problems, bodily pain, general health perceptions, vitality, social functioning, role limitations due to emotional problems, and mental health. The SF-36 is often used in clinical research and health services evaluation to measure health outcomes and quality of life.

Scoring: The SF-36 has eight scaled scores; the scores are weighted sums of the questions in each section. Scores range from 0 - 100

Lower scores = more disability, higher scores = less disability

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

2. Compared to one year ago

3. The following items are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much?


Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports

4. Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf

5. Lifting or carrying groceries

6. Climbing several flights of stairs

7. Climbing one flight of stairs

8. Bending, kneeling, or stooping

9. Walking more than a mile

10. Walking a block (around 260 feet)

11. Walking several blocks

12. Bathing or dressing yourself

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?


13. Cut down the amount of time you spent on work or other activities

14. Accomplished less than you would like

15. Were limited in the kind of work or other activities

16. Had difficulty performing the work or other activities (for example, it took extra effort)

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)?


17. Cut down the amount of time you spent on work or other activities

18. Accomplished less than you would like

19. Didn't do work or other activities as carefully as usual

20. During the past 4 weeks, to what extent has your physical health or emotional problems interfered with your normal social activities with family, friends, neighbors, or groups?

21. How much bodily pain have you had during the past 4 weeks?

22. During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)?

23. These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling


Did you feel full of pep?

24. Have you been a very nervous person?

25. Have you felt so down in the dumps that nothing could cheer you up?

26. Have you felt calm and peaceful?

27. Did you have a lot of energy

28. Have you felt downhearted and blue?

29. Did you feel worn out?

30. Have you been a happy person?

31. Did you feel tired?

32. During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting with friends, relatives, etc.)?

33. How TRUE or FALSE is each of the following statements for you.


a. I seem to get sick a little easier than other people

34. I am as healthy as anybody I know

35. I expect my health to get worse

36. My health is excellent

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Healsens BV
Kranenhout 39
2134 XC Hoofddorp

+31 6 12683966
contact@healsens.com

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contact

Healsens B.V.
Kranenhout 39
2134 XC Hoofddorp

+31 6 12683966
contact@healsens.com

network
Facebook Linkedin Instagram Youtube
policies

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