Quality of Life Assessment

This assessment asks how you feel about your quality of life, health, and other areas of your life. Please answer all the questions. If you are unsure about which response to give to a question, please choose the one that appears most appropriate.

Please keep in mind your standards, hopes, pleasures and concerns. Think about your life in the last two weeks.

Your Email

Emotional Well-being

Very Poor
Poor
Neither Poor nor Good
Good
Very Good
Not at all
A small amount
A moderate amount
A great deal
An extreme amount
Not at all
A small amount
A moderate amount
A great deal
An extreme amount
Not at all
Slightly
Moderately
Very
Extremely
Not at all
Slightly
Moderately
Very much
Completely
Very dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied
Satisfied
Very satisfied
Very dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied
Satisfied
Very satisfied

Physical Health

Very dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied
Satisfied
Very satisfied
Not at all
A little
A moderate amount
Very much
An extreme amount
Not at all
A small amount
A moderate amount
A great deal
An extreme amount
Not at all
Slightly
Moderately
Very
Extremely
Not at all
A little
Moderately
Mostly
Completely
Very poorly
Poorly
Neither poor nor well
Well
Very well
Very dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied
Satisfie
Satisfied
Very satisfied

Financial Well-being

Not at all
A little
Moderately
Mostly
Completely
Very dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied
Satisfied
Very satisfied
Very dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied
Satisfied
Very satisfied
Very dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied
Satisfied
Very satisfied

Intellectual Well-being

Not at all
A little
Moderately
Mostly
Completely
Very dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied
Satisfied
Very satisfied
Very dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied
Satisfied
Very satisfied

Social Well-being

Not at all
A little
Moderately
Mostly
Completely
Very dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied
Satisfied
Very satisfied

Spiritual Well-being

Not at all
A little
Moderately
Very much
Extremely
Never
Infrequently
Sometimes
Frequently
Very frequently