Cross-Sectional Survey
Please complete this survey to help us understand your background and perspectives. Your responses will remain confidential.
Participant Information
Please provide your basic demographic details.
Full Name
First Name
Last Name
Email Address
example@example.com
Age Group
*
Please Select
Under 18
18-24
25-34
35-44
45-54
55-64
65 or older
Gender
*
Male
Female
Prefer not to say
Non-binary/Other
Highest Level of Education Completed
*
Please Select
No formal education
High school or equivalent
Associate degree
Bachelor’s degree
Master’s degree
Doctorate or higher
Other
Employment Status
*
Employed full-time
Employed part-time
Self-employed
Unemployed
Student
Retired
Other
How satisfied are you with your current quality of life?
*
Not satisfied at all
1
2
3
4
Very satisfied
5
1 is Not satisfied at all, 5 is Very satisfied
How often do you engage in physical activity each week?
*
Never
1-2 times
3-4 times
5 or more times
Please indicate your agreement with the following statements:
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I feel connected to my community.
1
2
3
4
5
I am optimistic about the future.
6
7
8
9
10
I have access to the resources I need.
11
12
13
14
15
How would you rate your overall health?
*
1
2
3
4
5
What is your primary source of information on current events?
*
Television
Online news websites
Social media
Radio
Newspapers
Friends/Family
Other
Please share any additional comments or feedback.
Submit Survey
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