SF-36







PLEASE ANSWER THE FOLLOWING 36 QUESTIONS OF THIS HEALTH SURVEY COMPLETELY, HONESTLY AND WITHOUT INTERRUPTIONS.




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?












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?






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)?








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












How true or false is each of the following statements for you?





THANK YOU FOR COMPLETING THIS QUESTIONNAIRE.