With 1 being completely satisfied and 7 being extremely unsatisfied, how would you rate your current level of dissatisfaction in each of the following categories:
being not at all and 7 being severely, to
what degree do each of the following items impact your execution of regular,
daily tasks and activities?
Would you like to share your spouse or partner's information in your application? Partner may be defined as your girlfriend or boyfriend, significant other, or caretaker.