Wellness Questionnaire
  • Name
  • Age
  • Gender
  • What is your job category?

  • What is your annual income?

  • Are you especially concerned for your health?

  • On average, how often do you visit a general practitioner in a month?
  • Which, if any, of these ailments do you suffer from? Choose all that apply.

  • Which, if any of these, ailments concern you (whether due to family history, lifestyle, previous experience, or other)? Choose all that apply. 

  • On average, how long do you sleep?
  • Typically, how often do you workout?
  • How long does your typical workout last?
  • How active is your lifestyle?

  • Do you smoke?

  • How often do you smoke? 

  • Do you drink?

  • How often do you drink?
  • Rate how much emotional support you feel you have from your friends/relative. 

  • How often do you attend social gatherings (club meetings, family gatherings, and others)?

  • How often do you feel lonely?

  • How often do you feel stressed in a typical week?
  • How do you manage your stress?

  • How healthy would you rate yourself to be?

That's all, folks!

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