Wellness Questionnaire
  • Name
  • Age
  • Gender
  • Which occupational category do you belong to?
  • What is your annual income?
  • Do you consider yourself specially 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 are you concerned about (either due to family history, lifestyle, previous experience etc)? 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?
  • Do you feel you have emotional support from your friends/relative?
  • How often do you attend social gatherings (club meetings, family gatherings, and others)?
  • 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!