CONSOLIDATION TEST

TASK 1

TASK 2 CREATE YOUR OWN SURVEY

HEALTH SURVEY
Then we make some questions regarding your health Circle the appropriate
number for your response (one answer per question) The following questions
relate to what you think about your health. Your responses will know how you are
and how far it is able to do your usual activities. Answer each question as
indicated. If you are not sure / how to answer a question, please answer what
seems truer.
1. In general, would you say your health is
Excellent ................. 1
Very good ............... 2
Good ....................... 3
Regular .................... 4
Mala ........................ 5
2. How do you say is your current health, compared to a year ago?
Much better now than one year ago ................ 1
Somewhat better now than one year ago ........ 2
More or less the same as a year ago ................ 3
Worse now than a year ago .............................. 4
Much worse now than a year ago .................... 5
3. During the past 4 weeks, to what extent has your physical health or emotional
problems interfered with your normal social activities with family, friends, neighbors
or others?
Nothing ................. 1
A little .................... 2
Regular .................. 3
Pretty .................... 4
Much ..................... 5
4. Did you have pain somewhere in the body during the past 4 weeks?
No, none .............. 1
Yes, very little ....... 2
Yes, a little ............ 3
Yes, moderate....... 4
Yes, much ............. 5
Yes, very much ..... 6

5. During the past 4 weeks, to what extent does the pain interfere with your normal
work (including work outside the home and housework)?
Nothing ................. 1
A little .................... 2
Regular .................. 3
Pretty .................... 4
Much ..................... 5
6. During the past 4 weeks how often have physical health or emotional problems
interfered with her social activities (like visiting friends or relatives)?
Always ............................... 1
Almost always ................... 2
Sometimes ........................ 3
Only once .......................... 4
Never ................................. 5
7. At some point in your life did you come to think seriously about the possibility of
suicide, to kill himself?
Yes ........... 1
No ......... 2
8. Are These thoughts have had in the last 12 months?
Yes ........... 1
No ......... 2
9. How do you think is your social life?
Very satisfactory .................................... 1
Rather satisfactory ................................. 2
Rather unsatisfactory ............................. 3
Very unsatisfactory ................................. 4
10. Do you consider your overall health is ...?
Very good ................................................ 1
Good ................................................ ....... 2
Normal ................................................. ... 3
Mala ................................................. ....... 4

Very bad ................................................ .. 5

11. Enter a figure
Approximately how much you weigh without shoes? ______kilogramos
12. Enter a figure
Approximately How tall without shoes? ______centimeters
13. Depending on your height, do you think that your current weight is?
Excessive .............. 1
Normal ................. 2
Scarce .................. 3
14. Are you. Satisfied with his / her weight or would like to weigh more or less than
what is currently weigh?
- I am satisfied / a with my current weight ............... 1
- I would lose weight .................................... 2
- I would gain weight ..................................... 3
14. Could you tell me approximately how many hours a day do you usually sleep?
________Hours
16. Did you cares for people under 15 living at home?
Always or almost always ...........................................1
Intermittently, sharing with my partner ................... 2
Intermittently, sharing with a person hired .............. 3
Rarely ............................................... ........................ 4
Never ........ .................................................................5
17. Do you deal with the special care of disabled people living at home?
Always or almost always ...........................................1
Intermittently, sharing with my partner .................... 2
Intermittently, sharing with a person hired .............. 3
Rarely ............................................... ......................... 4
Never ......... .................................................................5
18. Did you cares for people over 65 living at home?
Always or almost always ............................................1

Intermittently, sharing with my partner .................... 2

Intermittently, sharing with a person hired .............. 3
Rarely ............................................... ......................... 4
Never ........ .................................................. ..............5
It is not necessary fend for themselves ..................... 6
19. Do you take (or will take) blood pressure at least once a year?
Yes ........... 1
No ......... 2
20. When have taken (or you have taken) the tension last?
Never................................................. ............... 1
Less than a year ago ......................................... 2
over a year ago and less than two ................... 3
More than two and less than three years ........ 4
less than 4 years over 3 and 5 ..........................5
more than four years ago ................................. 6
21. Have you ever been told you have hypertension?
Yes ........... 1
No ......... 2