Question Title

* 1. Please enter your ID Code and Zip/Postal Code.

Question Title

* 2. Please enter today's date. 

Date
This survey has just 15 questions, many similar to ones that you have seen, or will see on other surveys in this study.  Please read each question and carefully rank your responses according to your health experience in the last 30 days.   

Question Title

* 3. Mark how often this statement is true.

  Always Most of the time Sometimes Rarely Never
I cough.

Question Title

* 4. Mark how often this statement is true.

  Always Most of the time Sometimes Rarely Never
I feel optimistic about my life.

Question Title

* 5. Mark how often this statement is true.

  Always Most of the time Sometimes Rarely Never
I sleep soundly and get a good night's sleep.

Question Title

* 6. Mark how often this statement is true.

  Always Most of the time Sometimes Rarely Never
I worry about the future.

Question Title

* 7. Mark how often this statement is true.

  Always Most of the time Sometimes Rarely Never
I can notice an unpleasant body sensation without worrying about it.

Question Title

* 8. Mark how often each statement is true.

  Always Most of the time Sometimes Rarely Never
I have phlegm.

Question Title

* 9. Mark how often this statement is true.

  Always Most of the time Sometimes Rarely Never
When I am tense, I notice where the tension is located in my body.

Question Title

* 10. Mark how often this statement is true.

  Always Most of the time Sometimes Rarely Never
I am aware of my body posture and alignment.

Question Title

* 11. Mark how often this statement is true.

  Always Most of the time Sometimes Rarely Never
I use body awareness as a resource.

Question Title

* 12. Mark how often this statement is true.

  Always Most of the time Sometimes Rarely Never
I have tightness in my chest.

Question Title

* 13. Mark how often this statement is true.

  Always Most of the time Sometimes Rarely Never
When walking uphill (upstairs) I can converse with another person.

Question Title

* 14. Mark how often this statement is true.

  Always Most of the time Sometimes Rarely Never
My joints and muscles are free of pain and stillness.

Question Title

* 15. Mark how often this statement is true.

  Always Most of the time Sometimes Rarely Never
My body aches and I feel fatigued.

Question Title

* 16. Mark how often this statement is true.

  Always Most of the time Sometimes Rarely Never
I can use my breath to reduce tension.

Question Title

* 17. Mark how often each statement is true.

  Always Most of the time Sometimes Rarely Never
I feel safe and comfortable going away from my home by myself.
Thank you for your time. 

T