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Promis Global Health Test

PROMIS Global Health

Form

PROMIS Global Health
Form

Outstanding Tasks0

Complete Tasks Below
Click on the items below to complete.

Promis Global Health Test

PROMIS Global Health

Form

PROMIS Global Health
Form

PROMIS Global Health


Please respond to each question or statement by marking one box per row.

In general, would you say your health is:*

In general, would you say your quality of life is:*

In general, how would you rate your physical health?*

In general, how would you rate your mental health, including your mood and your ability to think?*

In general, how would you rate your satisfaction with your social activities and relationships?*

In general, please rate how well you carry out your usual social activities and roles. (This includes activities at home, at work and in your community, and responsibilities as a parent, child, spouse, employee, friend, etc.)*

Excellent
Very Good
Good
Fair
Poor
In general, would you say your health is:
In general, would you say your quality of life is:
In general, how would you rate your physical health?
In general, how would you rate your mental health, including your mood and your ability to think?
In general, how would you rate your satisfaction with your social activities and relationships?
In general, please rate how well you carry out your usual social activities and roles. (This includes activities at home, at work and in your community, and responsibilities as a parent, child, spouse, employee, friend, etc.)
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To what extent are you able to carry out your everyday physical activities such as walking, climbing stairs, carrying groceries, or moving a chair?*

Completely
Mostly
Moderately
A little
Not at all
To what extent are you able to carry out your everyday physical activities such as walking, climbing stairs, carrying groceries, or moving a chair?
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In the past 7 days...

How often have you been bothered by emotional problems such as feeling anxious, depressed or irritable?*

Never
Rarely
Sometimes
Often
Always
How often have you been bothered by emotional problems such as feeling anxious, depressed or irritable?
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In the past 7 days...

How would you rate your fatigue on average?*

None
Mild
Moderate
Severe
Very Severe
How would you rate your fatigue on average?
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