(Please enter your BEST email address.)
(Please include area code)
(Ex: 1/1/2000 3:45 pm)
(Please check all that apply.)
(Ex: Son 23, Daughter 18)
On a scale of 1-5 with 1 being very unhappy and 5 being very happy:
(Please be as detailed as possible)
List: Light, Moderate, Intense, or a combination
Ex: Occasionally, daily, weekly, monthly, etc...
Ex: Read, bike rides, hike, swim, spend time with friends and family, etc...
- Thank you for your time and candor.
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