*1.Which gender do you identify with?(Required.)

Male

Female

Transgender

Do not identify as female, male, or transgender

*2.Select your age range.(Required.)

Under 18

18-24

25-34

35-44

45-54

55-64

65+

*3.Over the last 12 months would you say your overall health and well being has been:(Required.)

Very good

Fairly good

Not very good

Not good at all

4.Overall,

0 Not at all

1

2

3

4

5 Completely

How satisfied are you with your Physical well-being?

0 Not at all

1

2

3

4

5 Completely

How optimistic do you feel about your Physical health in the next 12 months?

0 Not at all

1

2

3

4

5 Completely

5.Overall, 

0 Not at all

1

2

3

4

5 Completely

How satisfied are you with your Emotional well-being?

0 Not at all

1

2

3

4

5 Completely

How optimistic do you feel about your Emotional health in the next 12 months?

0 Not at all

1

2

3

4

5 Completely

6.Overall, 

0 Not at all

1

2

3

4

5 Completely

How satisfied are you with your Spiritual well-being?

0 Not at all

1

2

3

4

5 Completely

How optimistic do you feel about your Spiritual health in the next 12 months?

0 Not at all

1

2

3

4

5 Completely

*7.Over the past 12 months have you done any of the following in an attempt to keep fit and healthy? (Check all the apply.)(Required.)

Followed a fitness program (e.g. gym, sports training, etc.)

Maintained a long term active lifestyle (e.g. playing sport, cycling, walking, etc.)

Recently taken up a more active lifestyle

Tried to eat a healthier diet (e.g. vegetarian, vegan, etc.)

Gone on a diet to lose weight

Tried to reduce stress levels (e.g. meditation, breathing, etc.)

Tried to reduce or give up drinking alcohol

Other (please specify)

None of the above

8.Have any of the following behaviors ever been part of your lifestyle?

Never done this

Used to but gave it up

Have reduced doing this

Still do this

Smoking

Never done this

Used to but gave it up

Have reduced doing this

Still do this

Drinking

Never done this

Used to but gave it up

Have reduced doing this

Still do this

Using recreational drugs

Never done this

Used to but gave it up

Have reduced doing this

Still do this

Being dependent upon prescription drugs

Never done this

Used to but gave it up

Have reduced doing this

Still do this

Eating excessively

Never done this

Used to but gave it up

Have reduced doing this

Still do this

Sedentary lifestyle

Never done this

Used to but gave it up

Have reduced doing this

Still do this

Eating too much sugar

Never done this

Used to but gave it up

Have reduced doing this

Still do this

*9.When I become anxious or feel like I have too much to do in too little time, I...(Check all that apply.)(Required.)

Keep doing what I am doing and plow through

Take a break

Exercise

Meditate

Eat

Take medication

Go outside

Other (please specify)

*10.I regularly spend time in solitude and silence to connect with my spirituality. This enables me to be still and undistracted in nature.(Required.)

Very true

Sometimes true

Mostly true

Not very true