Black Womxn and Femmes: Mini Quality of Life Survey
Hey y'all! A super mini version of the longer QLS. The larger survey is intended for black identifying womxn and femmes, but anyone may take this mini version.

So, If you want: pick a quiet spot, tune into yourself, and spend 10-15 minutes in your feelings about your lived experiences.

Responses can be anonymous, and you can skip any question, for any reason.

Feel free to reach out to me, Desiree, at nanacsapothecary@gmail.com.

So much gratitude for you!
Name
Your answer
Gender (all inclusive)
Your answer
Race (all inclusive)
Your answer
Age
Your answer
Zip code
Your answer
I believe that the following factors lead to a happy (content or fulfilling) life--check up to SEVEN factors.
On a scale of 0-10, I consider myself a happy, content or satisfied person.
extremely unhappy
extremely happy
I enjoy my life:
I am hopeful about my future.
I have three or more people that I can go to for help if:
yes
no
I don't know
not applicable
I'm sick
I'm having trouble paying my bills
I'm having emotional problems
I Need someone to watch my children
I Need someone to help with my elderly parents
I need a hug or physical touch
I Feel comfortable in my body.
In the past three months, I've:
Not at all
a bit less than usual
no more than usual
a bit more than usual
much more than usual
I don't know
Been able to concentrate on what I'm doing
Lost sleep over worrying
Felt under pressure or strain
Felt I couldn't overcome my difficulties
Been feeling unhappy or depressed
Been losing confidence in myself
If I or someone in my household had to make an unexpected payment of $5,000 today, I would (check all that apply):
My overall quality of life might improve if I: (please share whatever tool, skill, resource or circumstances that YOU feel you would need)
Your answer
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