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