Religion and Health Survey
Please complete this survey to help us understand the relationship between religious practices and health. Your responses are confidential and will be used for research purposes only.
Full Name
First Name
Last Name
Age
*
Gender
*
Female
Male
Non-binary
Prefer not to say
Religious affiliation
*
Please Select
Christianity
Islam
Hinduism
Buddhism
Judaism
Other
None
How frequently do you participate in religious activities?
*
Daily
Weekly
Monthly
Rarely
Never
How would you rate your overall health?
*
1
2
3
4
5
Please indicate your agreement with the following statements.
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
My religious beliefs have a positive impact on my health.
1
2
3
4
5
I use prayer or meditation to cope with health challenges.
6
7
8
9
10
My religious community supports my well-being.
11
12
13
14
15
I believe there is a connection between spirituality and physical health.
16
17
18
19
20
Do you have any chronic health conditions?
*
Yes
No
How often do you engage in the following health behaviors?
*
Rows
Never
Rarely
Sometimes
Often
Always
Eat a balanced diet
21
22
23
24
25
Exercise regularly
26
27
28
29
30
Avoid smoking
31
32
33
34
35
Limit alcohol consumption
36
37
38
39
40
Please share any additional comments or insights about the relationship between religion and health.
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