.
Lifestyle Change Survey
Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.
Start
Secured
Survio
1
How old are you?
Select your age group.
under 25
25-35
36-45
46-55
over 55
2
Gender
Select your gender.
Female
Male
Other
Prefer not to say
3
How often do you exercise per week?
Indicate the frequency of your weekly exercise routine.
4
Rate your current diet
Rate your diet on a scale from 1 to 10, where 1 is poor and 10 is excellent.
5
How many hours of sleep do you get per night?
Enter the average number of hours you sleep per night.
6
Do you practice any stress-reducing activities?
Specify if you engage in any activities to reduce stress.
Yes
No
7
Rate your stress levels
Rate your stress levels on a scale from 1 to 10, where 1 is low and 10 is high.
8
How often do you engage in social activities?
Indicate the frequency of your participation in social activities.
Daily
Weekly
Monthly
Rarely
Never
9
Are you satisfied with your current work-life balance?
Reflect on your satisfaction level regarding work-life balance.
Yes
No
10
Any additional comments or suggestions for improving overall well-being?
Feel free to share any extra thoughts or recommendations for enhancing your overall well-being.
Submit