SF-12

SF-12

 

    PLEASE ANSWER THE FOLLOWING 12 QUESTIONS OF THIS HEALTH SURVEY COMPLETELY,
    HONESTLY AND WITHOUT INTERRUPTIONS.
    Choose one option for each questionnaire item.

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

    2. Does your health limit you performing moderate physical activities, such as moving a table, pushing a vacuum cleaner or playing golf?

    3. Does your health limit you climbing several flights of stairs?

    4. As a result of your physical health, have you accomplished less than you would have like to during the last 4 weeks?

    5. As a result of your physical health, have you been limited in the kind of work or other activities during the last 4 weeks?

    6. As a result of emotional problems, during th last 4 weeks, have you accomplished less than you would like?

    7. As a result of emotional problems, during the past 4 weeks have you not done work of other activities as carefully as usual?

    8. During the past 4 weeks, how much did pain interfere with your normal work?

    10. Have you had a lot of energy?

    11. Have you felt downhearted and blue?

    12. Has your physical or mental health interfered with your social activities?

    THANK YOU FOR COMPLETING THIS QUESTIONNAIRE

    STAFF USE ONLY
    Participants NHS Number:
    Researchers Name:
    NHS Site Number:
    NHS Site Name:
    Postcode: