Question Title

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

Question Title

* 2. Please enter today's date. 

Date / Time
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 each statement is true.

  Always Most of the time Sometimes Rarely Never
I cough
I feel optimistic about my life. 
I sleep soundly and get a good night's sleep. 
I worry about the future.
I can notice an unpleasant body sensation without worrying about it. 
I have phlegm. 
When I am tense, I notice where the tension is located in my body. 
I am aware of my body posture and alignment. 
I use body awareness as a resource. 
I have tightness in my chest. 
When walking uphill (upstairs) I can converse with another person.
My joints and muscles are free of pain and stillness. 
My body aches and I feel fatigued. 
I can use my breath to reduce tension. 
I feel safe and comfortable going away from my home by myself. 
Thank you for your time. 

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