1. What is your age? (Optional)
2. If I had to live my life all over again, I wouldn't change anything. Agree Disagree
3. You will be happy at this very moment if ____________.
4. Please mention the three things that you think contribute significantly toward your happiness.
5. What is the highest level of education you have completed? (Optional) High School Diploma Associate Degree Bachelor Degree Master's Degree PhD or Professional Degree (J.D.,M.D.etc.) Other
6. How would you rate your health these days? Excellent Very good Good Fair Poor
7. Please specify your family status. Married Living with partner Separated Divorced Widowed Single (never married) Other
8. Please specify your gender. (Optional) Male Female
9. How would you rate your overall level of happiness? Very high High Average Low Very low
10. How satisfied are you with the following things in your life?
11. If you are married, how satisfied are you with your marriage? Very satisfied Satisfied Dissatisfied Very Dissatisfied
12. Please select the option that best describes your opinion regarding the following.
13. If your answer to the previous question is "Disagree", then please specify that one thing you would like to change about your life.
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