| Section 1 : Material Wealth |
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| 1. |
What is your annual salary? |
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| 2. |
How many credit cards do you own? |
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| 3. |
What year is the make of your car? |
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| 4. |
Have you ever declared bancrupcy? |
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Yes
No
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| 5. |
Do you have a retirement fund? |
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Yes
No
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| 6. |
Do you have a savings account? |
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Yes
No
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| 7. |
Do you own your own house? |
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Yes
No
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| Section 2 : Body Wealth |
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| 8. |
Are you Male or Female |
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Male
Female
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| 9. |
How old are you? |
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| 10. |
Do you smoke? |
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Yes
No
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| 11. |
Do you drink? |
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Yes
No
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| 12. |
How much exercise do you get a week? |
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| 13. |
What is your weight? |
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| 14. |
Are you on daily medication? |
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Yes
No
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| Section 3 : Emotional Wealth |
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| 15. |
Have you ever been divorced? |
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Yes
No
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| 16. |
Do you have any kids? |
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Yes
No
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| 17. |
How many hours has it been since you last laughed? |
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| 18. |
How many days has it been since you last cried? |
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| 19. |
How many days has it been since you last kissed someone? |
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| 20. |
Rate how happy you are with your life |
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| 21. |
Rate your love life |
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