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Quality of Life Survey Questions + Sample Questionnaire Template

The quality of life survey helps collect demographic data as well as quality of life data from a wide range of respondents. These survey questions can be used to collect data about an individual and society on general on various parameters like overall quality of life, natural environment, health, housing, community, overall well-being and community and social culture. The most effective use of this survey is by any council, government, consortium, school or organization to collect data about the quality of life of people that are associated with them.


1. Please select your gender
2. What is your highest education level completed?
3. What is your marital status?
4. What is your ethnicity?
5. Please select your employment type
6. During the past 6 months, you have lived: (select all that is applicable)
7. Please select your housing type
8. Please select the most appropriate answer options
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I am happy with the house I live in
I am satisfied with the hygiene around the house
My neighbors are good
I am satisfied with the food that I eat
I am happy with the clothes I wear
I have a decent paying job
I hang out with my friends quite often
I am satisfied with my personal safety
I pursue at least one hobby
I have a healthy relationship with my parents
9. How important are the following aspects of your life?
Not at all important
Slightly important
Moderately important
Very important
Extremely important
Having a good house to stay in
The way I spend my time on a regular basis
I need good food to eat
I need to mentally healthy
I need a good means of transportation
A healthy sex life
10. Which of the following would be your regular activity? Select all that is applicable
11. Please select Yes or No for each of the following questions.
Yes
No
I am happy about achieving something good in the last 4 weeks.
I feel left out and odd with people around me
I am bored very easily
Lack of concentration in the last 4 weeks
Extremely restless and jumpy
Have put on a lot of weight in the last 6 months
Happy because I received compliments from family and friends
Depressed and unhappy
Particularly excited about something
12. How would you rate your mental health over the past 4 weeks?
13. How would you rate your physical health over the past 4 weeks?
14. Have you ever been for psychiatric consultation?
15. How often do you consume alcohol?
16. Do you use drugs or any other substance?
17. How often do you consume drugs?
18. How often does lack of money keep you from doing the things you wish to do?
19. Please select all the activities you have done in the past 4 weeks
20. How important are the following factors in determining your quality of life?
Not at all important
Slightly important
Moderately important
Very important
Extremely important
Work/school
How you feel about yourself
Your physical state of being
Your mental state of being
Your family/ friends
Your bank balance

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