Health

In general, would you say your health is:

How much bodily pain have you generally had during the past month:

How much does the pain affect your daily activities?

Over the last month, how often have you been bothered by a lack of interest in doing things:

Not at all

Several days

More than half the days

Nearly every day

How often have you been bothered by thinking of taking your own life:

Not at all

Once a day

Once a week

Once a month

How often do you go to your general doctor:

Weekly

Monthly

Annually

How often do you use medication:

Can you get to places out of walking distances:

Without help

With some help

Completely unable to travel unless special arrangements are made

How often do you feel stressed:

During the past month, how much of the time have you been a happy person: