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Home
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Self-assessment surveys
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General Health Questionnaire
General Health Questionnaire
1 / 19
In general, would you say your health is:
Please choose one of the options
Excellent
Very good
Good
Fair
Poor
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2 / 19
I seem to get sick a little easier than other people
Please choose one of the options
Definitely true
Mostly true
Don’t know
Mostly false
Definitely false
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3 / 19
I am as healthy as anybody I know
Please choose one of the options
Definitely true
Mostly true
Don’t know
Mostly false
Definitely false
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4 / 19
I expect my health to get worse
Please choose one of the options
Definitely true
Mostly true
Don’t know
Mostly false
Definitely false
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5 / 19
My health is excellent
Please choose one of the options
Definitely true
Mostly true
Don’t know
Mostly false
Definitely false
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6 / 19
Compared to one year ago, how would you rate your health in general now?
Please choose one of the options
Much better than one year ago
Somewhat better than one year ago
About the same
Somewhat worse now than one year ago
Much worse than one year ago
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7 / 19
How much bodily pain have you had during the past 4 weeks?
Please choose one of the options
None
Very mild
Mild
Moderate
Severe
Very severe
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8 / 19
During the past four weeks, how much did pain interfere with your normal work (including both work outside the home and housework)?
Please choose one of the options
Not at all
A little bit
Moderately
Quite a bit
Extremely
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9 / 19
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?
Please choose one of the options
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10 / 19
Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports.
Please choose one of the options
Yes, limited a lot
Yes, limited a little
No, not limited at all
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11 / 19
Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf
Please choose one of the options
Yes, limited a lot
Yes, limited a little
No, not limited at all
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12 / 19
Lifting or carrying groceries
Please choose one of the options
Yes, limited a lot
Yes, limited a little
No, not limited at all
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13 / 19
Climbing several flights of stairs.
Please choose one of the options
Yes, limited a lot
Yes, limited a little
No, not limited at all
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14 / 19
Climbing one flight of stairs.
Please choose one of the options
Yes, limited a lot
Yes, limited a little
No, not limited at all
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15 / 19
Bending, kneeling, or stooping
Please choose one of the options
Yes, limited a lot
Yes, limited a little
No, not limited at all
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16 / 19
Walking more than a mile
Please choose one of the options
Yes, limited a lot
Yes, limited a little
No, not limited at all
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17 / 19
Walking several blocks
Please choose one of the options
Yes, limited a lot
Yes, limited a little
No, not limited at all
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18 / 19
Walking one block
Please choose one of the options
Yes, limited a lot
Yes, limited a little
No, not limited at all
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19 / 19
Bathing or dressing yourself.
Please choose one of the options
Yes, limited a lot
Yes, limited a little
No, not limited at all
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