Life purpose |
There is a leader in your life who makes you enthusiastic about the future |
Strongly agree, agree, neutral, disagree, strongly disagree |
You like what you do every day |
Strongly agree, agree, neutral, disagree, strongly disagree |
In the past 12 months, you have reached most of your goals |
Strongly agree, agree, neutral, disagree, strongly disagree |
You get to use your strengths to do what you do best every day |
Strongly agree, agree, neutral, disagree, strongly disagree |
You learn or do something interesting every day |
Strongly agree, agree, neutral, disagree, strongly disagree |
Residential Community Belonging |
The city or area where you live is a perfect place for you |
Strongly agree, agree, neutral, disagree, strongly disagree |
You are proud of your community or the area where you live |
Strongly agree, agree, neutral, disagree, strongly disagree |
You always feel safe and secure |
Strongly agree, agree, neutral, disagree, strongly disagree |
In the last 12 months, you have received recognition for helping to improve the city or area where you live |
Strongly agree, agree, neutral, disagree, strongly disagree |
Physical and Mental Health |
Your physical health is near-perfect |
Strongly agree, agree, neutral, disagree, strongly disagree |
In the last seven days, you have felt active and productive every day |
Strongly agree, agree, neutral, disagree, strongly disagree |
Over the last two weeks, how often have you had little interest or pleasure in doing things? |
Nearly every day, more than half the days, several days, not at all |
Do you have any health problems that prevent you from doing any of the things people your age normally can do? |
Yes, no |
Did you experience the following feelings during a lot of the day yesterday?… Physical pain |
Yes, no |
Did you eat healthy all day yesterday? Do you smoke? |
Yes, no |
Have you ever been told by a physician or nurse that you have any of the following, or no? |
|
… High blood pressure |
Yes, no |
… High cholesterol |
Yes, no |
… Diabetes |
Yes, no |
… Depression |
Yes, no |
… Heart attack |
Yes, no |
… Cancer |
Yes, no |
In the last seven days, on how many days did you |
|
… Exercise for 30 or more minutes |
0 days, 1 day, 2 days, 3 days, 4 days, 5 days, 6 days, 7 days |
… Have five or more servings of fruits and vegetables |
0 days, 1 day, 2 days, 3 days, 4 days, 5 days, 6 days, 7 days |
BMI |
|
What is your height? |
Feet Inches |
What is your approximate weight? |
Pounds |
Financial Well-being |
Have there been times in the past twelve months when you did not have enough money to buy food that you or your family needed? |
Yes, no |
You have enough money to do everything you want to do. |
Strongly agree, agree, neutral, disagree, strongly disagree |
In the last seven days, you have worried about money. |
Strongly agree, agree, neutral, disagree, strongly disagree |
Compared to the people you spend time with, you are satisfied with your standard of living. |
Strongly agree, agree, neutral, disagree, strongly disagree |
Social Connectedness |
Your relationship with your spouse, partner, or closest friend is stronger than ever. |
Strongly agree, agree, neutral, disagree, strongly disagree |
You always make time for regular trips or vacations with friends and family. |
Strongly agree, agree, neutral, disagree, strongly disagree |
Someone in your life always encourages you to be healthy. |
Strongly agree, agree, neutral, disagree, strongly disagree |
Your friends and family give you positive energy every day. |
Strongly agree, agree, neutral, disagree, strongly disagree |