Foundation for Well Being - Needs Survey
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1. Welcome to the Foundation for Well Being survey
In order to be of greater service, we want to find out what you need. Please take a few moments to answer the following questions. Your input is very much appreciated and important to us.
1
. Why did you come to this site? What were you searching for? Choose all that apply.
Why did you come to this site? What were you searching for? Choose all that apply.
Serious illness
Relationship problems
Financial hardship
Grief
Advice for my ‘next’ step
Advancement on my spiritual path
Peace of mind
Stress
Stress at work
Stress from medical problems
Dissatisfaction with life
Concern about the world
Fear in my life
Other (please specify)
2
. What do you need to have more of in your life? Choose all that apply.
What do you need to have more of in your life? Choose all that apply.
Health and health of loved ones
Wealth
Happiness
Time to meditate
A support system
Money
I don’t know, I’m trying to find out
Direction
Other (please specify)
3
. What are you feeling right now? Choose all that apply.
What are you feeling right now? Choose all that apply.
It’s not fair
Why me?
I didn’t sign up for this
I don’t deserve this
Helpless
Depressed
Confused
Lost
Afraid
Unloved
Angry
Resentful
Stressed
None of the above
Other (please specify)
4
. What would you like to feel right now? Choose all that apply.
What would you like to feel right now? Choose all that apply.
Hopeful
Joyful
Peaceful
Free
Happy
Fulfilled
Grateful
Successful
Good enough
Worthy
Other (please specify)
5
. What area of your life concerns you most right now? Choose all that apply.
What area of your life concerns you most right now? Choose all that apply.
My health
The health of family member or friend
My finances
Work relationships
Getting a job
The economy
The state of the world
My children
My spouse
Other (please specify)
6
. If you had a fairy godmother/godfather who could wave a magic wand right now, what would you ask for? Choose all that apply.
If you had a fairy godmother/godfather who could wave a magic wand right now, what would you ask for? Choose all that apply.
Money
Meaningful work
Great job
Happiness
Home/food/transportation – just the basics
My health back
A loved one’s health back
A loved one back
Peace of mind
Harmony in relationships
A sense of purpose
Answers to the mysteries of life
Other (please specify)
7
. What did you find helpful on The Foundation for Well Being website?
What did you find helpful on The Foundation for Well Being website?
8
. What would you like to see added to the Foundation for Well Being Website
What would you like to see added to the Foundation for Well Being Website
9
. Tell us about yourself (check all that apply)
Tell us about yourself (check all that apply)
Male
Female
Single
Married
Married with children
Living with Significant Other
Widowed
Divorced
30 years old or younger
30 – 50 years old
50-70 years old
70 – 90 years old
Older than 90
Income less than $25,000/year
Income $25,000- $75,000/year
Income above $75,000/year
Live in Rural area
Live in Urban (city) area
Other (please specify)
10
. Would you like to volunteer your services (time, money, experience) to the Foundation for Well Being?
Would you like to volunteer your services (time, money, experience) to the Foundation for Well Being?
YES (please write contact information in box below)
NO
Contact Information
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