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Tellegacy
Call us: (701) 997-1363 | social@tellegacy.com
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Name
Email
Age
Gender
Race
Education Level
Profession
City
State
Country
Economic Stability
Do you have access to educational resources or training opportunities that help you achieve your financial goals?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Does your financial situation enable you to access quality healthcare services without significant stress?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Does your neighborhood provide opportunities, resources, or support that help you achieve financial stability?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Do you have someone you trust to discuss your financial goals and challenges, who provides emotional or practical support?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Are you able to afford healthy and nutritious food consistently for yourself and your family?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Does your current economic situation allow you to engage in meaningful work or recreational activities that bring you fulfillment?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Do you feel satisfied with your financial stability and progress toward your economic goals?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
How would you rate your stress level related to your financial situation, if any?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Education Access and Quality
Does your financial situation impact your ability to pursue educational opportunities or training?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Do you feel that your education has prepared you to make informed decisions about your health and access healthcare effectively?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Are there local resources, such as libraries, internet access, or community programs, that support your educational goals?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Do you have a support system (e.g., family, friends, or mentors) encouraging and motivating you to pursue education or training?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Does your access to education include programs or resources on maintaining good nutrition and health?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Has your education prepared you for meaningful work or fulfilling recreational activities that align with your goals?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
How satisfied are you with the quality and accessibility of educational opportunities available to you?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
How would you rate your stress level related to your current educational situation or lack of access, if any?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Healthcare Access and Quality
Do you have the financial means, such as insurance or other supports, to access necessary healthcare services without significant hardship?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Do you feel informed and educated about how to access healthcare services and make decisions about your health?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Are there quality healthcare providers or facilities easily accessible in your neighborhood or community?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Do you have someone you trust to help you navigate healthcare decisions or provide support during health-related challenges?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Do you have access to nutritional support or counseling to help maintain or improve your health?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Does your healthcare access support your ability to work or participate in recreational activities without undue stress or limitations?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
How satisfied are you with your access to quality healthcare and the care you receive?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
How do you rate your stress level in managing your healthcare related needs, if any?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Neighborhood and Built Environment
Does your neighborhood offer opportunities for financial growth or stability, such as jobs or affordable living options?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Are there resources in your neighborhood that support education or skill development, such as schools, libraries, or internet access?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Is there adequate access to quality healthcare services, pharmacies, or wellness programs in your neighborhood?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Do you feel a sense of community and safety in your neighborhood that supports your overall well-being?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Do you have access to affordable and nutritious food options within your neighborhood?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Does your neighborhood provide opportunities for meaningful work or recreational activities that support your personal or professional goals?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
How satisfied are you with the opportunities and resources available in your neighborhood?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
How do you rate your current stress level related to living in your neighborhood, if any?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Social and Community Context
Do you have people in your life who provide emotional or practical support for achieving financial stability or economic goals?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Does your social network encourage or provide resources for educational growth or lifelong learning?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Are there individuals in your social circle who help you navigate healthcare decisions or provide support during health challenges?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Do you feel a sense of belonging and connection in your community or neighborhood?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Do you have people who support you in maintaining a healthy diet or access to nutritious food?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Do you feel supported by your social or professional network in pursuing meaningful work or recreational activities?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
How fulfilled do you feel with the level of connection and support you receive from your social networks?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Please rate your stress level regarding your social relationships, if any?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Food and Nutrition
Do you have the financial means to consistently purchase nutritious and sufficient food for yourself and your family?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Do you feel you have adequate knowledge or education about maintaining a healthy diet and its benefits?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Do you have access to nutritional counseling or programs that support your health needs?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Are there affordable and nutritious food options available in your neighborhood or community?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Do you have a support system that helps you maintain healthy eating habits or provides food when needed?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Does your access to food support your ability to engage in work or recreational activities without feeling fatigued or unhealthy?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
How satisfied are you with your current access to nutritious and sufficient food?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Please rate your stress level regarding obtaining or maintaining access to nutritious food, if any?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Work and Recreation
Does your work provide financial stability and allow you to meet your economic goals?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Do you feel your education has adequately prepared you for your current work or recreational pursuits?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Does your physical and mental health allow you to fully engage in meaningful work, activity, or recreation?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Are there opportunities in your community for recreational or work-related activities that bring you fulfillment?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Do you feel supported by coworkers, mentors, or friends in your work or recreational activities?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
Do you feel your access to nutritious food supports your energy and well-being for work and recreation?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
How satisfied are you with the sense of purpose and fulfillment you gain from your work and recreational activities?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
To what extend do you rate your stress in managing your work and recreation activities, if any?
To a Very Great Extent
To a Great Extent
To a Moderate Extent
Somewhat
To a Small Extent
Very Little
Not at All
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