Quality of Life Survey
Please select your gender.
Female
Male
Other
Please select marital status.
Married
Single
Divorced
Separated
Widowed
What is your highest education level that you have completed?
What is your employment status right now?
What is your ethnicity?
What is your annual income?
Are you happy with where you live? Please give details.
Do you think that your relatives/neighbors/friends are nice people? Please give details.
Is eating good food important for you?
Yes
No
Do have any hobbies?
Yes
No
If yes, how often do you spend time on your hobby(s)?
Are you satisfied with the health/sanitation in your current location?
Yes
No
If no, explain why?
Can you practice your faith without any obstacles?
Yes
No
1
Rows
Yes
No
Can you practice your faith without any obstacles?
2
3
Are you extremely restless or jumpy?
4
5
Are there enough avenues for you to indulge in physical activities?
6
7
Do you feel irritated with everyone around you?
8
9
How would you rate your mental health over the last 4 weeks?
Worst
1
2
3
4
5
6
7
8
9
Best
10
1 is Worst, 10 is Best
How would you rate your physical health over the last 4 weeks?
1
2
3
4
5
6
7
8
9
10
Additional Notes
Submit
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