Questions
Your Response
What is your marital status ?
Please Select
Married
Engaged
Single
Divorced
Separated
Widowed
Other
*
Would you or have you ever cheated on your partner ?
Please Select
Yes
No
*
What is your sexual orientation ?
Please Select
Heterosexual (Straight)
Homosexual
Bisexual
Asexual (No preference)
*
Have you ever had a sexually transmitted infection (STI) ?
Please Select
Yes
No
*
How many sexual partners have you had in the last 12 months ?
Please Select
None
1
2
3
4
5
6
7 or more
*
Have you ever had a one night stand ?
Please Select
Yes
No
*
Have you ever slept with someone and regretted it in the morning ?
Please Select
Yes
No
*
Do you and your partner use contraception ?
Please Select
Yes
No
*
How long have you been with your current employer ?
Please Select
< 1 year
1 - 2 years
2 - 3 years
3 - 4 years
4 - 5 years
> 5 years
I own my own company
*
Approximately how many hours a week do you work for pay ?
Please Select
Do not work
Less than 10
10 - 15
16 - 25
26 - 40
Over 40
*
Do you get on with your boss ?
Please Select
Yes
Mostly
Sometimes
No
I am the boss
*
Have you ever been the victim of sexual harrasment at work ?
Please Select
Yes
No
*
What % of your salary is spent on your rent / mortgage ?
Please Select
Do not pay rent / mortgage
0 - 10%
11 - 20%
21 - 30%
31 - 40%
41 - 50%
Over 50%
*
How much debt are you in excluding any mortgage amount ?
Please Select
I have no debt
£0 - £1,000
£1,000 to £2,500
£2,500 - £5,000
£5,000 - £10,000
£10,000 - £20,000
Over £20,000
*
Would you consider yourself to be a shopaholic ?
Please Select
Yes
No
*
Do you drink alcoholic beverages ?
Please Select
Yes
No
*
How many total mixed drinks, beers & glasses of wine do you consume on a night out ?
Please Select
None
1 - 5
6 - 10
11 - 15
16 or more
*
How many days a week do you consume alcohol ?
Please Select
0
1
2
3
4
5
6
7
*
On a typical Saturday, when you would drink alcohol ?
Please Select
Usually do not drink
In the morning
In the afternoon
In the evening
Throughout the day
*
How would you consider your drinking behaviour ?
Please Select
A non drinker
Almost a non drinker
Just a social drinker
A moderate drinker
A heavy drinker
A problem drinker
*
Have you ever driven under the influence of alcohol ?
Please Select
Yes
No
*
Have you ever worked under the influence of alcohol ?
Please Select
Yes
No
*
Have you ever taken illegal drugs ?
Please Select
Yes
No
*
Would you consider yourself to be overweight ?
Please Select
Yes
No
*
Have you ever attempted to lose weight through exercise ?
Please Select
Yes
No
*
Have you ever attempted to lose weight through diet ?
Please Select
Yes
No
*
Are you a smoker ?
Please Select
Yes
No
*
Have you got an illness which affects your quality of life ?
Please Select
Yes
No
*
Are you male / female ?
Please Select
Male
Female
*
What age band do you fall into ?
Please Select
Under 16
16 - 19
20 - 24
25 - 29
30 - 39
40 - 49
Over 50
*
