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Isolation

What is your name? (if comfortable)
Date of Birth
What is your Gender? (if you're comfortable to say)
Male
Female
Non-binary
Prefer to not say
Have you felt lonely lately?
Yes
No
If yes on the last question, how often have you felt lonely?
1
2
3
4
5
6
7
8
9
10
How likely are you to be a social butterfly?
Very Likely
Likely
Neither likely nor unlikely
Unlikely
Very Unlikely
I would like to be more social in my life?
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
What's stopping you from being social?
How satisfied are you with yourself?
Very Satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very Dissatisfied
What made you this way?
What is your outlet to help you not be lonely?
How hard would it be to try and change?
Very easy
Easy
Neither easy nor difficult
Difficult
Very difficult
How hard is it to make friends?
Very easy
Easy
Neither easy nor difficult
Difficult
Very difficult
Would you like to make a friend?
Yes
No
Any socials that you have? (Instagram, Snapchat, Facebook, ect.)
Email, so I am notified that the survey is taken
Did this help get some inner emotions out?
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