Behavioural Assessment
This questionnaire is designed to assess your thoughts, feelings, behaviours, opinions, attitudes and beliefs related to your lifestyle and general well-being.

There are no right or wrong answers.

Please enter your initials: *
Your answer
Sex *
Date of birth *
MM
/
DD
/
YYYY
Marital status: *
Your answer
How many children do you have? *
Your answer
Highest level of education completed: *
Your answer
Current occupation: *
Your answer
Your current living situation:
Choose all that apply
living alone
living with children
living with roommates
living with spouse/partner
living with parents
living with other relatives
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