Choose one option for each questionnaire item


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?
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



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.
How much of the time during the past 4 weeks...











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