During a 24 hour day, how many hours of sleep do you usually get?

During the past four weeks, how would you rate your sleep quality overall?

How much physical pain have you had during the past four weeks?

During the past four weeks, how much energy did you have?

During the past four weeks, how much did your physical health problems limit your usual social activities (such as going to social events, having meals and visits with friends or family, etc.)?

In the past four weeks, how much did physical health problems limit your usual physical activities (such as walking or climbing stairs, etc.)?

Overall, how would you rate your health during the past four weeks?

How many serious injuries have you had in the last 6 months?

In the past year, have you been seen by an emergency room doctor?

Do you meet with your physician at least once a year for a check-up and any recommended medical tests?