Notice How
GoOD Things Are.
 
       
Questionnaire
All information supplied is confidential, will not be shared with any
other organization and may be used for this research project only.
Findings will be published on this site (cancerpreventionresearch.org)
when completed. Any results that allude to respondees will be anonymous.

Question #1: I view my life as being free from stress.

always usually sometimes occasionally seldom rarely never
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Question #2: I enjoy exercise and take time to do so regularly.

always usually sometimes occasionally seldom rarely never
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Question #3: I tend to be an optimist - I look for the “silver lining” when things get tough.

always usually sometimes occasionally seldom rarely never
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Question #4: I find things to appreciate.

always usually sometimes occasionally seldom rarely never
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Question #5: I have a tendency to not worry a lot.

always usually sometimes occasionally seldom rarely never
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Question #6: I believe that “stumbling blocks” are “stepping stones.”

always usually sometimes occasionally seldom rarely never
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Question #7: I laugh a lot.

always usually sometimes occasionally seldom rarely never
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Question #8: My habitual use of tobacco products impels me to consider quitting.
(check "never" if you do not use tobacco products)

always usually sometimes occasionally seldom rarely never
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Question #9: If I we’re to get caught up in an anger situation or condition,
in which it seemed to be a “catch 22” or no way out, I would
believe I could find a way through it.

always usually sometimes occasionally seldom rarely never
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Question #10: I find myself in satisfying relationships.

always usually sometimes occasionally seldom rarely never
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Question #11: I believe that bad things don't “just happen.”

always usually sometimes occasionally seldom rarely never
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Question #12: I am open to diplomatically making major life changes in order for me to feel
better, regardless of what others might think or feel.

always usually sometimes occasionally seldom rarely never
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Question #13: I believe that I’m ultimately 100% responsible for
all of my experiences and conditions.

always usually sometimes occasionally seldom rarely never
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Question #14: I believe in God - in some Loving Creative Intelligence and Source Energy.

always usually sometimes occasionally seldom rarely never
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Question #15: If conditions in my life caused me to decide to make a change,
in order for me to feel better, I would not give up until I made it - regardless
of the consequences.

always usually sometimes occasionally seldom rarely never
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Question #16: I believe that there is a life after death.

always usually sometimes occasionally seldom rarely never
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Question #17: It has been said that “heaven is within us” - I believe that.

always usually sometimes occasionally seldom rarely never
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Question #18: I don't believe it is wrong to feel anger.

always usually sometimes occasionally seldom rarely never
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Question #19: I don't think it is better to keep my feelings to myself.

always usually sometimes occasionally seldom rarely never
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Question #20: I enjoy being with others.

always usually sometimes occasionally seldom rarely never
_________________________________________________________________________

Date of Birth:

Month: Day: Year: Time (if known):

Male Female

Cancer Status (Required): Never had Now have In Remission

Religion (Beliefs): Protestant Catholic Buddhist

Email:
Married Single Divorced Widow(er) In a relationship

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