Social Support Survey
Name (optional)
First Name
Last Name
Age
Please Select
15-18
18-25
25-35
35+
Gender
Please Select
Female
Male
How often is each of the following kinds of support available to you if you need it?
Rows
None of the time
A little of the time
Some of the time
Most of the time
All of the time
Someone to help you if you were confined to bed
1
2
3
4
5
Someone you can count on to listen to you when you need to talk
6
7
8
9
10
Someone to give you good advice about a crisis
11
12
13
14
15
Someone to take you to the doctor if you needed it
16
17
18
19
20
Someone who shows you love and affection
21
22
23
24
25
Someone to have a good time with
26
27
28
29
30
Someone to give you information to help you understand a situation
31
32
33
34
35
Someone to confide in or talk to about yourself or your problems
36
37
38
39
40
Someone who hugs you
41
42
43
44
45
Someone to get together with for relaxation
46
47
48
49
50
Someone to prepare your meals if you were unable to do it yourself
51
52
53
54
55
Someone whose advice you really want
56
57
58
59
60
Someone to do things with to help you get your mind off things
61
62
63
64
65
Someone to help with daily chores if you were sick
66
67
68
69
70
Submit
Should be Empty: