Survey Form




Male
Female
Other

upto 20
20 to 39
40 -59
60 and above




Very Bad / Strongly Disagree
Bad / Disagree
Average / Neutral
Good / Agree
Very Good / Strongly Agree

Very Bad / Strongly Disagree
Bad / Disagree
Average / Neutral
Good / Agree
Very Good / Strongly Agree

Very Bad / Strongly Disagree
Bad / Disagree
Average / Neutral
Good / Agree
Very Good / Strongly Agree

Very Bad / Strongly Disagree
Bad / Disagree
Average / Neutral
Good / Agree
Very Good / Strongly Agree

Very Bad / Strongly Disagree
Bad / Disagree
Average / Neutral
Good / Agree
Very Good / Strongly Agree

Very Bad / Strongly Disagree
Bad / Disagree
Average / Neutral
Good / Agree
Very Good / Strongly Agree

Very Bad / Strongly Disagree
Bad / Disagree
Average / Neutral
Good / Agree
Very Good / Strongly Agree

Very Bad / Strongly Disagree
Bad / Disagree
Average / Neutral
Good / Agree
Very Good / Strongly Agree

Very Bad / Strongly Disagree
Bad / Disagree
Average / Neutral
Good / Agree
Very Good / Strongly Agree

Very Bad / Strongly Disagree
Bad / Disagree
Average / Neutral
Good / Agree
Very Good / Strongly Agree

Very Bad / Strongly Disagree
Bad / Disagree
Average / Neutral
Good / Agree
Very Good / Strongly Agree

Very Bad / Strongly Disagree
Bad / Disagree
Average / Neutral
Good / Agree
Very Good / Strongly Agree

Very Bad / Strongly Disagree
Bad / Disagree
Average / Neutral
Good / Agree
Very Good / Strongly Agree

Very Bad / Strongly Disagree
Bad / Disagree
Average / Neutral
Good / Agree
Very Good / Strongly Agree

Very Bad / Strongly Disagree
Bad / Disagree
Average / Neutral
Good / Agree
Very Good / Strongly Agree

Very Bad / Strongly Disagree
Bad / Disagree
Average / Neutral
Good / Agree
Very Good / Strongly Agree

Very Bad / Strongly Disagree
Bad / Disagree
Average / Neutral
Good / Agree
Very Good / Strongly Agree

Very Bad / Strongly Disagree
Bad / Disagree
Average / Neutral
Good / Agree
Very Good / Strongly Agree

Very Bad / Strongly Disagree
Bad / Disagree
Average / Neutral
Good / Agree
Very Good / Strongly Agree

Very Bad / Strongly Disagree
Bad / Disagree
Average / Neutral
Good / Agree
Very Good / Strongly Agree

Very Bad / Strongly Disagree
Bad / Disagree
Average / Neutral
Good / Agree
Very Good / Strongly Agree

Very Bad / Strongly Disagree
Bad / Disagree
Average / Neutral
Good / Agree
Very Good / Strongly Agree

Very Bad / Strongly Disagree
Bad / Disagree
Average / Neutral
Good / Agree
Very Good / Strongly Agree

Yes
No

Yes
No

Yes
No

Yes
No

Yes
No

Never
Almost never
Half the time
Almost always
Always