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* 1. Age?

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* 2. Gender?

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* 3. Do you personally struggle with mental health or have ever had to battle with your mental health before?

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* 4. If you answered yes, when was it developed within your life? /When did you notice it and when did it become a problem if that was the case? (optional / only answer if comfortable)

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* 5. What do you believe causes mental health to decline?

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* 6. How would you rate your health as of today?

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* 7. Does your mood /mental health effect how productive you are throughout the day and your motivation?

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* 8. Do you feel that your mental health affects your relationships with friends and family, etc?

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* 9. Within your personal experience with mental health how do you feel it has impacted you and did it affect your physical health?

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* 10. On a scale from 1 to 10. How well would you say you cope with your overall health? (Physical and mental) 1- I definitely struggle with my health. 10- I feel I can take care of my health. 

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