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Questionnaire template

Life Satisfaction Self-Reflection

An informal reflection for adults on satisfaction with life overall, its main areas and how it is changing.

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Healthcare · Mental health assessment. All Healthcare templates

Questions in this template

Your Life Overall

  1. This short reflection asks how you feel about your life as a whole and about its main areas. There are no right or wrong answers.

  2. This is an informal self-reflection, not a validated scale or a clinical assessment.

  3. All things considered, how satisfied are you with your life these days?

    A number from 0 to 10:

    • 0
    • 5
    • 10

  4. How close is your life now to the life you hoped to have?

    Choose one:

    • Very close
    • Fairly close
    • Somewhat far
    • Very far

Areas of Your Life

  1. How satisfied are you with each of these parts of your life?

    • Your health
    • Your relationships with family and friends
    • Your work or studies
    • Your financial situation
    • Your free time
    • Where you live

    For each row: choose one:

    • Very dissatisfied
    • Dissatisfied
    • Neither satisfied nor dissatisfied
    • Satisfied
    • Very satisfied

  2. Which one of these areas would you most like to improve?

    Choose one:

    • Health
    • Relationships
    • Work or studies
    • Finances
    • Free time
    • Where I live
    • None in particular

  3. What would make the biggest difference in that area? (optional)

    Condition: Shown when an area was chosen

    Open answer

Change Over Time

  1. Compared with a year ago, how satisfied are you with your life now?

    Choose one:

    • Much more satisfied
    • Somewhat more satisfied
    • About the same
    • Somewhat less satisfied
    • Much less satisfied

  2. A year from now, do you expect to be more or less satisfied with your life than today?

    Choose one:

    • More satisfied
    • About the same
    • Less satisfied
    • Hard to say

  3. How much do you feel you can shape the way your life turns out?

    Choose one:

    • A great deal
    • A fair amount
    • A little
    • Not at all

About You

  1. Which age group are you in?

    Choose one:

    • 18-24
    • 25-34
    • 35-44
    • 45-54
    • 55-64
    • 65 or older

  2. What is your main activity at present?

    Choose one:

    • Employed or self-employed
    • Student
    • Looking for work
    • Caring for home or family
    • Retired
    • Other