Wellbeing - Health and Social Questionnaire 1 - Health and Social Question Title * 1. For you, which three words in the list below best define 'wellbeing'?Please number 1 to 3 (where 1 is the best definition) (Required.) Prosperous Comfort Safe and Secure Happiness Motivated Healthy Well connected Active Cared for Independent Question Title * 2. Which three of these are most important to your sense of wellbeing?Number 1-3 in order of importance (Required.) My family My friends My neighbours My local community Availability of local services The courtesy of strangers My independence Question Title * 3. How important would you say friends are to your wellbeing?Tick one box only (Required.) Very Important Important Not so Important Not Important at all Question Title * 4. How important is money to your wellbeing?Tick one box only (Required.) Essential Very Important Important Not so Important Not Important at all Question Title * 5. How would you describe the quality of your social life?Tick one box only (Required.) Very good Good Moderation (neither good or bad) Not very good I have no social life Question Title * 6. How would you describe your current health?Tick one box only (Required.) Excellent Very good Good Moderate Not very good I have a long term limiting illness or disability Question Title * 7. Which three of these do you value most as you grow older?Number in order of importance 1 to 3 (Required.) Health of my spouse/partner Comfort/security of my family The state of my neighbourhood People listening to me and acting on my needs Having access to good information and advice Availability of local services Support and care Having friends and peers close by Being able to look after myself as long as possible Question Title * 8. How important is the wellbeing of your family to your own wellbeing?Tick one box only (Required.) Very Important Important Not so Important Not Important at all Question Title * 9. Do you ever feel lonely?Tick one box only (Required.) All of the time Much of the time Quite often Occasionally Never Question Title * 10. Which of these do you consider affect your own wellbeing?Tick all that apply (Required.) My physical disability My long term limiting illness My mental health The health of my family None of these Not sure Question Title * 11. How important is exercise to you?Tick one box only (Required.) Very Important Quite Important Not so Important Not Important at all Question Title * 12. How important to you is companionship?Tick one box only (Required.) Very important Quite important Not so important Not important at all Next
