Activist Psychological Study - Please Participate!

An exploratory study is being done to determine if there are unique psychological attributes of people working for social change which differ from the general population. <!--break--> An exploratory study is being done to determine if there are unique psychological attributes of people working for social change which differ from the general population. Three measures are used, as shown below. The survey takes approximately 5-10 minutes to complete; participation is voluntary and anonymous; no IP addresses or other personal information is logged. Results of the survey will be posted at a future time. Any partially filled out surveys will be disregarded; only complete surveys with every question answered (except for gender) will count. <p> <form method="post" action="http://208.56.47.79/study.php"> Your gender (optional):<p> <input type="radio" name="x_1" value="a">Male<br> <input type="radio" name="x_1" value="b">Female<br> <p> <center><b>For each of the following pairs of questions,<br>choose the one that is most consistent with your view of the world.</b></center> <p> <input type="radio" name="a_1" value="a">Children get into trouble because their patents punish them too much.<br> <input type="radio" name="a_1" value="b">The trouble with most children nowadays is that their parents are too easy with them. <p> <input type="radio" name="a_2" value="a">Many of the unhappy things in people's lives are partly due to bad luck.<br> <input type="radio" name="a_2" value="b">People's misfortunes result from the mistakes they make. <p> <input type="radio" name="a_3" value="a">One major reason why we have wars is because people don't take enough interest in politics.<br> <input type="radio" name="a_3" value="b">There will always be wars, no matter how hard people try to prevent them. <p> <input type="radio" name="a_4" value="a">In the long run people get the respect they deserve in this world.<br> <input type="radio" name="a_4" value="b">Unfortunately, an individual's worth often passes unrecognized no matter how hard he tries. <p> <input type="radio" name="a_5" value="a">The idea that teachers are unfair to students is nonsense.<br> <input type="radio" name="a_5" value="b">Most students don't realize the extent to which grades are influenced by chance. <p> <input type="radio" name="a_6" value="a">Without the right breaks one cannot be an effective leader.<br> <input type="radio" name="a_6" value="b">Capable people who fail to become leaders hive not taken advantage of their opportunities. <p> <input type="radio" name="a_7" value="a">No matter how hard you try some people just don't like you.<br> <input type="radio" name="a_7" value="b">People who can't get others to like them don't understand how to get along with others. <p> <input type="radio" name="a_8" value="a">Heredity plays the major role in determining one's personality.<br> <input type="radio" name="a_8" value="b">It is one's experiences in life which determine what they're like. <p> <input type="radio" name="a_9" value="a">I have often found that what is going to happen will happen.<br> <input type="radio" name="a_9" value="b">Trusting fate never turns out as well as making a decision to take a definite course of action. <p> <input type="radio" name="a_10" value="a">In the case of the well-prepared student, there is rarely if ever such a thing as an unfair test. <br> <input type="radio" name="a_10" value="b">Many times exam questions are so unrelated to course work that studying is really useless. <p> <input type="radio" name="a_11" value="a">Becoming a success is a matter of hard work, luck has little or nothing to do with it.<br> <input type="radio" name="a_11" value="b">Getting a good job depends mainly on being in the right place at the right time. <p> <input type="radio" name="a_12" value="a">The average citizen can have an influence in government decisions.<br> <input type="radio" name="a_12" value="b">The world is run by a few people in power, and there isnít much everyone else can do about it. <p> <input type="radio" name="a_13" value="a">When I make plans, I am almost certain that I can make them work.<br> <input type="radio" name="a_13" value="b">It is not wise to plan too far ahead because many things turn out to- be a matter of luck. <p> <input type="radio" name="a_14" value="a">There are certain people who are just no good.<br> <input type="radio" name="a_14" value="b">There is some good in everybody. <p> <input type="radio" name="a_15" value="a">In my case getting what I want has little or nothing to do with luck.<br> <input type="radio" name="a_15" value="b">Many times we might just as well decide what to do by flipping a coin. <p> <input type="radio" name="a_16" value="a">Who gets to be the boss often depends on who was lucky enough to be in the right place first.<br> <input type="radio" name="a_16" value="b">Getting people to do the right thing depends upon ability, luck has little to do with it. <p> <input type="radio" name="a_17" value="a">Concerning world affairs, most of us are victims of forces we canít understand or control.<br> <input type="radio" name="a_17" value="b">By taking an active part in political and social affairs the people can control world events. <p> <input type="radio" name="a_18" value="a">Most people don't realize the extent to which their lives are controlled by chance events.<br> <input type="radio" name="a_18" value="b">There really is no such thing as "luck." <p> <input type="radio" name="a_19" value="a">One should always be willing to admit mistakes.<br> <input type="radio" name="a_19" value="b">It is usually best to cover up one's mistakes. <p> <input type="radio" name="a_20" value="a">It is hard to know whether or not a person really likes you.<br> <input type="radio" name="a_20" value="b">How many friends you have depends upon how nice a person you are. <p> <input type="radio" name="a_21" value="a">In the long run the bad things that happen to us are balanced by the good ones.<br> <input type="radio" name="a_21" value="b">Most misfortunes are the result of lack of ability, ignorance, laziness, or all three. <p> <input type="radio" name="a_22" value="a">With enough effort we can wipe out political corruption.<br> <input type="radio" name="a_22" value="b">It is difficult for people to have much control over the things politicians do in office. <p> <input type="radio" name="a_23" value="a">Sometimes I can't understand how teachers arrive at the grades they give.<br> <input type="radio" name="a_23" value="b">There is a direct connection between how hard 1 study and the grades I get. <p> <input type="radio" name="a_24" value="a">A good leader expects people to decide for themselves what they should do.<br> <input type="radio" name="a_24" value="b">A good leader makes it clear to everybody what their jobs are. <p> <input type="radio" name="a_25" value="a">Many times 1 feel that I have little influence over the things that happen to me.<br> <input type="radio" name="a_25" value="b">It is impossible for me to believe that chance or luck plays an important role in my life. <p> <hr> <center><b>Select the description that best fits you.</b></center> <p> I feel downhearted, blue, and sad...<br> <input type="radio" name="b_1" value="1">Never <input type="radio" name="b_1" value="2">Sometimes <input type="radio" name="b_1" value="3">Good Part of the time <input type="radio" name="b_1" value="4">Most of the time <p> Morning is when I feel the best...<br> <input type="radio" name="b_2" value="1">Never <input type="radio" name="b_2" value="2">Sometimes <input type="radio" name="b_2" value="3">Good Part of the time <input type="radio" name="b_2" value="4">Most of the time <p> I have crying spells or feel like it...<br> <input type="radio" name="b_3" value="1">Never <input type="radio" name="b_3" value="2">Sometimes <input type="radio" name="b_3" value="3">Good Part of the time <input type="radio" name="b_3" value="4">Most of the time <p> I have trouble sleeping through the night...<br> <input type="radio" name="b_4" value="1">Never <input type="radio" name="b_4" value="2">Sometimes <input type="radio" name="b_4" value="3">Good Part of the time <input type="radio" name="b_4" value="4">Most of the time <p> I eat as much as I used to...<br> <input type="radio" name="b_5" value="1">Never <input type="radio" name="b_5" value="2">Sometimes <input type="radio" name="b_5" value="3">Good Part of the time <input type="radio" name="b_5" value="4">Most of the time <p> I enjoy looking at, talking to, and being with attractive women/men...<br> <input type="radio" name="b_6" value="1">Never <input type="radio" name="b_6" value="2">Sometimes <input type="radio" name="b_6" value="3">Good Part of the time <input type="radio" name="b_6" value="4">Most of the time <p> I notice that I am losing weight...<br> <input type="radio" name="b_7" value="1">Never <input type="radio" name="b_7" value="2">Sometimes <input type="radio" name="b_7" value="3">Good Part of the time <input type="radio" name="b_7" value="4">Most of the time <p> I have trouble with constipation...<br> <input type="radio" name="b_8" value="1">Never <input type="radio" name="b_8" value="2">Sometimes <input type="radio" name="b_8" value="3">Good Part of the time <input type="radio" name="b_8" value="4">Most of the time <p> My heart beats faster than usual...<br> <input type="radio" name="b_9" value="1">Never <input type="radio" name="b_9" value="2">Sometimes <input type="radio" name="b_9" value="3">Good Part of the time <input type="radio" name="b_9" value="4">Most of the time <p> I get tired for no reason...<br> <input type="radio" name="b_10" value="1">Never <input type="radio" name="b_10" value="2">Sometimes <input type="radio" name="b_10" value="3">Good Part of the time <input type="radio" name="b_10" value="4">Most of the time <p> My mind is as clear as it used to be...<br> <input type="radio" name="b_11" value="1">Never <input type="radio" name="b_11" value="2">Sometimes <input type="radio" name="b_11" value="3">Good Part of the time <input type="radio" name="b_11" value="4">Most of the time <p> I find it easy to do the things I used to do...<br> <input type="radio" name="b_12" value="1">Never <input type="radio" name="b_12" value="2">Sometimes <input type="radio" name="b_12" value="3">Good Part of the time <input type="radio" name="b_12" value="4">Most of the time <p> I am restless and can't keep still...<br> <input type="radio" name="b_13" value="1">Never <input type="radio" name="b_13" value="2">Sometimes <input type="radio" name="b_13" value="3">Good Part of the time <input type="radio" name="b_13" value="4">Most of the time <p> I feel hopeful about the future...<br> <input type="radio" name="b_14" value="1">Never <input type="radio" name="b_14" value="2">Sometimes <input type="radio" name="b_14" value="3">Good Part of the time <input type="radio" name="b_14" value="4">Most of the time <p> I am more irritable than usual...<br> <input type="radio" name="b_15" value="1">Never <input type="radio" name="b_15" value="2">Sometimes <input type="radio" name="b_15" value="3">Good Part of the time <input type="radio" name="b_15" value="4">Most of the time <p> I find it easy to make decisions...<br> <input type="radio" name="b_16" value="1">Never <input type="radio" name="b_16" value="2">Sometimes <input type="radio" name="b_16" value="3">Good Part of the time <input type="radio" name="b_16" value="4">Most of the time <p> I feel that I am useful and needed...<br> <input type="radio" name="b_17" value="1">Never <input type="radio" name="b_17" value="2">Sometimes <input type="radio" name="b_17" value="3">Good Part of the time <input type="radio" name="b_17" value="4">Most of the time <p> My life is pretty full...<br> <input type="radio" name="b_18" value="1">Never <input type="radio" name="b_18" value="2">Sometimes <input type="radio" name="b_18" value="3">Good Part of the time <input type="radio" name="b_18" value="4">Most of the time <p> I feel that others would be better off if I were dead...<br> <input type="radio" name="b_19" value="1">Never <input type="radio" name="b_19" value="2">Sometimes <input type="radio" name="b_19" value="3">Good Part of the time <input type="radio" name="b_19" value="4">Most of the time <p> I still enjoy the things I used to do...<br> <input type="radio" name="b_20" value="1">Never <input type="radio" name="b_20" value="2">Sometimes <input type="radio" name="b_20" value="3">Good Part of the time <input type="radio" name="b_20" value="4">Most of the time <p> <hr> <p> <center><b>In the past 30 days, have you had...</b></center> <p> An upset stomach or nausea?<br> <input type="radio" name="c_1" value="1">No <input type="radio" name="c_1" value="2">Yes, but did NOT see a doctor <input type="radio" name="c_1" value="3">Yes, and I DID see a doctor <p> A backache?<br> <input type="radio" name="c_2" value="1">No <input type="radio" name="c_2" value="2">Yes, but did NOT see a doctor <input type="radio" name="c_2" value="3">Yes, and I DID see a doctor <p> Trouble sleeping?<br> <input type="radio" name="c_3" value="1">No <input type="radio" name="c_3" value="2">Yes, but did NOT see a doctor <input type="radio" name="c_3" value="3">Yes, and I DID see a doctor <p> A skin rash?<br> <input type="radio" name="c_4" value="1">No <input type="radio" name="c_4" value="2">Yes, but did NOT see a doctor <input type="radio" name="c_4" value="3">Yes, and I DID see a doctor <p> Shortness of breath?<br> <input type="radio" name="c_5" value="1">No <input type="radio" name="c_5" value="2">Yes, but did NOT see a doctor <input type="radio" name="c_5" value="3">Yes, and I DID see a doctor <p> Chest pain?<br> <input type="radio" name="c_6" value="1">No <input type="radio" name="c_6" value="2">Yes, but did NOT see a doctor <input type="radio" name="c_6" value="3">Yes, and I DID see a doctor <p> Headache?<br> <input type="radio" name="c_7" value="1">No <input type="radio" name="c_7" value="2">Yes, but did NOT see a doctor <input type="radio" name="c_7" value="3">Yes, and I DID see a doctor <p> Fever?<br> <input type="radio" name="c_8" value="1">No <input type="radio" name="c_8" value="2">Yes, but did NOT see a doctor <input type="radio" name="c_8" value="3">Yes, and I DID see a doctor <p> Acid indigestion or heartburn?<br> <input type="radio" name="c_9" value="1">No <input type="radio" name="c_9" value="2">Yes, but did NOT see a doctor <input type="radio" name="c_9" value="3">Yes, and I DID see a doctor <p> Eye strain?<br> <input type="radio" name="c_10" value="1">No <input type="radio" name="c_10" value="2">Yes, but did NOT see a doctor <input type="radio" name="c_10" value="3">Yes, and I DID see a doctor <p> Diarrhea?<br> <input type="radio" name="c_11" value="1">No <input type="radio" name="c_11" value="2">Yes, but did NOT see a doctor <input type="radio" name="c_11" value="3">Yes, and I DID see a doctor <p> Stomach cramps (not menstrual)?<br> <input type="radio" name="c_12" value="1">No <input type="radio" name="c_12" value="2">Yes, but did NOT see a doctor <input type="radio" name="c_12" value="3">Yes, and I DID see a doctor <p> Constipation?<br> <input type="radio" name="c_13" value="1">No <input type="radio" name="c_13" value="2">Yes, but did NOT see a doctor <input type="radio" name="c_13" value="3">Yes, and I DID see a doctor <p> Heart pounding when not exercising?<br> <input type="radio" name="c_14" value="1">No <input type="radio" name="c_14" value="2">Yes, but did NOT see a doctor <input type="radio" name="c_14" value="3">Yes, and I DID see a doctor <p> An infection?<br> <input type="radio" name="c_15" value="1">No <input type="radio" name="c_15" value="2">Yes, but did NOT see a doctor <input type="radio" name="c_15" value="3">Yes, and I DID see a doctor <p> Loss of appetite?<br> <input type="radio" name="c_16" value="1">No <input type="radio" name="c_16" value="2">Yes, but did NOT see a doctor <input type="radio" name="c_16" value="3">Yes, and I DID see a doctor <p> Dizziness?<br> <input type="radio" name="c_17" value="1">No <input type="radio" name="c_17" value="2">Yes, but did NOT see a doctor <input type="radio" name="c_17" value="3">Yes, and I DID see a doctor <p> Tiredness or fatique?<br> <input type="radio" name="c_18" value="1">No <input type="radio" name="c_18" value="2">Yes, but did NOT see a doctor <input type="radio" name="c_18" value="3">Yes, and I DID see a doctor <p> <hr> <center><input type="submit" value="---> CLICK HERE TO SUBMIT <---"></center> </form>

<p>An exploratory study is being done to determine if there are unique psychological attributes of people working for social change which differ from the general population.</p> <!--break--><p>An exploratory study is being done to determine if there are unique psychological attributes of people working for social change which differ from the general population. Three measures are used, as shown below. The survey takes approximately 5-10 minutes to complete; participation is voluntary and anonymous; no IP addresses or other personal information is logged. Results of the survey will be posted at a future time. Any partially filled out surveys will be disregarded; only complete surveys with every question answered (except for gender) will count.</p> <p></p><form method="post" action="http://208.56.47.79/study.php"> <p>Your gender (optional): </p><p><input type="radio" name="x_1" value="a" />Male<br /></p> <p><input type="radio" name="x_1" value="b" />Female<br /></p> <p></p><center><b>For each of the following pairs of questions,<br />choose the one that is most consistent with your view of the world.</b></center> <p><input type="radio" name="a_1" value="a" />Children get into trouble because their patents punish them too much.<br /></p> <p><input type="radio" name="a_1" value="b" />The trouble with most children nowadays is that their parents are too easy with them. </p> <p><input type="radio" name="a_2" value="a" />Many of the unhappy things in people's lives are partly due to bad luck.<br /></p> <p><input type="radio" name="a_2" value="b" />People's misfortunes result from the mistakes they make. </p> <p><input type="radio" name="a_3" value="a" />One major reason why we have wars is because people don't take enough interest in politics.<br /></p> <p><input type="radio" name="a_3" value="b" />There will always be wars, no matter how hard people try to prevent them. </p> <p><input type="radio" name="a_4" value="a" />In the long run people get the respect they deserve in this world.<br /></p> <p><input type="radio" name="a_4" value="b" />Unfortunately, an individual's worth often passes unrecognized no matter how hard he tries.</p> <p><input type="radio" name="a_5" value="a" />The idea that teachers are unfair to students is nonsense.<br /></p> <p><input type="radio" name="a_5" value="b" />Most students don't realize the extent to which grades are influenced by chance. </p> <p><input type="radio" name="a_6" value="a" />Without the right breaks one cannot be an effective leader.<br /></p> <p><input type="radio" name="a_6" value="b" />Capable people who fail to become leaders hive not taken advantage of their opportunities. </p> <p><input type="radio" name="a_7" value="a" />No matter how hard you try some people just don't like you.<br /></p> <p><input type="radio" name="a_7" value="b" />People who can't get others to like them don't understand how to get along with others. </p> <p><input type="radio" name="a_8" value="a" />Heredity plays the major role in determining one's personality.<br /></p> <p><input type="radio" name="a_8" value="b" />It is one's experiences in life which determine what they're like. </p> <p><input type="radio" name="a_9" value="a" />I have often found that what is going to happen will happen.<br /></p> <p><input type="radio" name="a_9" value="b" />Trusting fate never turns out as well as making a decision to take a definite course of action. </p> <p><input type="radio" name="a_10" value="a" />In the case of the well-prepared student, there is rarely if ever such a thing as an unfair test. <br /></p> <p><input type="radio" name="a_10" value="b" />Many times exam questions are so unrelated to course work that studying is really useless. </p> <p><input type="radio" name="a_11" value="a" />Becoming a success is a matter of hard work, luck has little or nothing to do with it.<br /></p> <p><input type="radio" name="a_11" value="b" />Getting a good job depends mainly on being in the right place at the right time. </p> <p><input type="radio" name="a_12" value="a" />The average citizen can have an influence in government decisions.<br /></p> <p><input type="radio" name="a_12" value="b" />The world is run by a few people in power, and there isnít much everyone else can do about it. </p> <p><input type="radio" name="a_13" value="a" />When I make plans, I am almost certain that I can make them work.<br /></p> <p><input type="radio" name="a_13" value="b" />It is not wise to plan too far ahead because many things turn out to- be a matter of luck. </p> <p><input type="radio" name="a_14" value="a" />There are certain people who are just no good.<br /></p> <p><input type="radio" name="a_14" value="b" />There is some good in everybody. </p> <p><input type="radio" name="a_15" value="a" />In my case getting what I want has little or nothing to do with luck.<br /></p> <p><input type="radio" name="a_15" value="b" />Many times we might just as well decide what to do by flipping a coin. </p> <p><input type="radio" name="a_16" value="a" />Who gets to be the boss often depends on who was lucky enough to be in the right place first.<br /></p> <p><input type="radio" name="a_16" value="b" />Getting people to do the right thing depends upon ability, luck has little to do with it. </p> <p><input type="radio" name="a_17" value="a" />Concerning world affairs, most of us are victims of forces we canít understand or control.<br /></p> <p><input type="radio" name="a_17" value="b" />By taking an active part in political and social affairs the people can control world events. </p> <p><input type="radio" name="a_18" value="a" />Most people don't realize the extent to which their lives are controlled by chance events.<br /></p> <p><input type="radio" name="a_18" value="b" />There really is no such thing as "luck." </p> <p><input type="radio" name="a_19" value="a" />One should always be willing to admit mistakes.<br /></p> <p><input type="radio" name="a_19" value="b" />It is usually best to cover up one's mistakes. </p> <p><input type="radio" name="a_20" value="a" />It is hard to know whether or not a person really likes you.<br /></p> <p><input type="radio" name="a_20" value="b" />How many friends you have depends upon how nice a person you are. </p> <p><input type="radio" name="a_21" value="a" />In the long run the bad things that happen to us are balanced by the good ones.<br /></p> <p><input type="radio" name="a_21" value="b" />Most misfortunes are the result of lack of ability, ignorance, laziness, or all three. </p> <p><input type="radio" name="a_22" value="a" />With enough effort we can wipe out political corruption.<br /></p> <p><input type="radio" name="a_22" value="b" />It is difficult for people to have much control over the things politicians do in office. </p> <p><input type="radio" name="a_23" value="a" />Sometimes I can't understand how teachers arrive at the grades they give.<br /></p> <p><input type="radio" name="a_23" value="b" />There is a direct connection between how hard 1 study and the grades I get. </p> <p><input type="radio" name="a_24" value="a" />A good leader expects people to decide for themselves what they should do.<br /></p> <p><input type="radio" name="a_24" value="b" />A good leader makes it clear to everybody what their jobs are. </p> <p><input type="radio" name="a_25" value="a" />Many times 1 feel that I have little influence over the things that happen to me.<br /></p> <p><input type="radio" name="a_25" value="b" />It is impossible for me to believe that chance or luck plays an important role in my life. </p> <p></p><hr /> <p></p><center><b>Select the description that best fits you.</b></center> <p>I feel downhearted, blue, and sad...<br /></p> <p><input type="radio" name="b_1" value="1" />Never</p> <p><input type="radio" name="b_1" value="2" />Sometimes</p> <p><input type="radio" name="b_1" value="3" />Good Part of the time</p> <p><input type="radio" name="b_1" value="4" />Most of the time</p> <p>Morning is when I feel the best...<br /></p> <p><input type="radio" name="b_2" value="1" />Never</p> <p><input type="radio" name="b_2" value="2" />Sometimes</p> <p><input type="radio" name="b_2" value="3" />Good Part of the time</p> <p><input type="radio" name="b_2" value="4" />Most of the time</p> <p>I have crying spells or feel like it...<br /></p> <p><input type="radio" name="b_3" value="1" />Never</p> <p><input type="radio" name="b_3" value="2" />Sometimes</p> <p><input type="radio" name="b_3" value="3" />Good Part of the time</p> <p><input type="radio" name="b_3" value="4" />Most of the time</p> <p>I have trouble sleeping through the night...<br /></p> <p><input type="radio" name="b_4" value="1" />Never</p> <p><input type="radio" name="b_4" value="2" />Sometimes</p> <p><input type="radio" name="b_4" value="3" />Good Part of the time</p> <p><input type="radio" name="b_4" value="4" />Most of the time</p> <p>I eat as much as I used to...<br /></p> <p><input type="radio" name="b_5" value="1" />Never</p> <p><input type="radio" name="b_5" value="2" />Sometimes</p> <p><input type="radio" name="b_5" value="3" />Good Part of the time</p> <p><input type="radio" name="b_5" value="4" />Most of the time</p> <p>I enjoy looking at, talking to, and being with attractive women/men...<br /></p> <p><input type="radio" name="b_6" value="1" />Never</p> <p><input type="radio" name="b_6" value="2" />Sometimes</p> <p><input type="radio" name="b_6" value="3" />Good Part of the time</p> <p><input type="radio" name="b_6" value="4" />Most of the time</p> <p>I notice that I am losing weight...<br /></p> <p><input type="radio" name="b_7" value="1" />Never</p> <p><input type="radio" name="b_7" value="2" />Sometimes</p> <p><input type="radio" name="b_7" value="3" />Good Part of the time</p> <p><input type="radio" name="b_7" value="4" />Most of the time</p> <p>I have trouble with constipation...<br /></p> <p><input type="radio" name="b_8" value="1" />Never</p> <p><input type="radio" name="b_8" value="2" />Sometimes</p> <p><input type="radio" name="b_8" value="3" />Good Part of the time</p> <p><input type="radio" name="b_8" value="4" />Most of the time</p> <p>My heart beats faster than usual...<br /></p> <p><input type="radio" name="b_9" value="1" />Never</p> <p><input type="radio" name="b_9" value="2" />Sometimes</p> <p><input type="radio" name="b_9" value="3" />Good Part of the time</p> <p><input type="radio" name="b_9" value="4" />Most of the time</p> <p>I get tired for no reason...<br /></p> <p><input type="radio" name="b_10" value="1" />Never</p> <p><input type="radio" name="b_10" value="2" />Sometimes</p> <p><input type="radio" name="b_10" value="3" />Good Part of the time</p> <p><input type="radio" name="b_10" value="4" />Most of the time</p> <p>My mind is as clear as it used to be...<br /></p> <p><input type="radio" name="b_11" value="1" />Never</p> <p><input type="radio" name="b_11" value="2" />Sometimes</p> <p><input type="radio" name="b_11" value="3" />Good Part of the time</p> <p><input type="radio" name="b_11" value="4" />Most of the time</p> <p>I find it easy to do the things I used to do...<br /></p> <p><input type="radio" name="b_12" value="1" />Never</p> <p><input type="radio" name="b_12" value="2" />Sometimes</p> <p><input type="radio" name="b_12" value="3" />Good Part of the time</p> <p><input type="radio" name="b_12" value="4" />Most of the time</p> <p>I am restless and can't keep still...<br /></p> <p><input type="radio" name="b_13" value="1" />Never</p> <p><input type="radio" name="b_13" value="2" />Sometimes</p> <p><input type="radio" name="b_13" value="3" />Good Part of the time</p> <p><input type="radio" name="b_13" value="4" />Most of the time</p> <p>I feel hopeful about the future...<br /></p> <p><input type="radio" name="b_14" value="1" />Never</p> <p><input type="radio" name="b_14" value="2" />Sometimes</p> <p><input type="radio" name="b_14" value="3" />Good Part of the time</p> <p><input type="radio" name="b_14" value="4" />Most of the time</p> <p>I am more irritable than usual...<br /></p> <p><input type="radio" name="b_15" value="1" />Never</p> <p><input type="radio" name="b_15" value="2" />Sometimes</p> <p><input type="radio" name="b_15" value="3" />Good Part of the time</p> <p><input type="radio" name="b_15" value="4" />Most of the time</p> <p>I find it easy to make decisions...<br /></p> <p><input type="radio" name="b_16" value="1" />Never</p> <p><input type="radio" name="b_16" value="2" />Sometimes</p> <p><input type="radio" name="b_16" value="3" />Good Part of the time</p> <p><input type="radio" name="b_16" value="4" />Most of the time</p> <p>I feel that I am useful and needed...<br /></p> <p><input type="radio" name="b_17" value="1" />Never</p> <p><input type="radio" name="b_17" value="2" />Sometimes</p> <p><input type="radio" name="b_17" value="3" />Good Part of the time</p> <p><input type="radio" name="b_17" value="4" />Most of the time</p> <p>My life is pretty full...<br /></p> <p><input type="radio" name="b_18" value="1" />Never</p> <p><input type="radio" name="b_18" value="2" />Sometimes</p> <p><input type="radio" name="b_18" value="3" />Good Part of the time</p> <p><input type="radio" name="b_18" value="4" />Most of the time</p> <p>I feel that others would be better off if I were dead...<br /></p> <p><input type="radio" name="b_19" value="1" />Never</p> <p><input type="radio" name="b_19" value="2" />Sometimes</p> <p><input type="radio" name="b_19" value="3" />Good Part of the time</p> <p><input type="radio" name="b_19" value="4" />Most of the time</p> <p>I still enjoy the things I used to do...<br /></p> <p><input type="radio" name="b_20" value="1" />Never</p> <p><input type="radio" name="b_20" value="2" />Sometimes</p> <p><input type="radio" name="b_20" value="3" />Good Part of the time</p> <p><input type="radio" name="b_20" value="4" />Most of the time</p> <p></p><hr /> <p></p><center><b>In the past 30 days, have you had...</b></center> <p>An upset stomach or nausea?<br /></p> <p><input type="radio" name="c_1" value="1" />No</p> <p><input type="radio" name="c_1" value="2" />Yes, but did NOT see a doctor</p> <p><input type="radio" name="c_1" value="3" />Yes, and I DID see a doctor</p> <p>A backache?<br /></p> <p><input type="radio" name="c_2" value="1" />No</p> <p><input type="radio" name="c_2" value="2" />Yes, but did NOT see a doctor</p> <p><input type="radio" name="c_2" value="3" />Yes, and I DID see a doctor</p> <p>Trouble sleeping?<br /></p> <p><input type="radio" name="c_3" value="1" />No</p> <p><input type="radio" name="c_3" value="2" />Yes, but did NOT see a doctor</p> <p><input type="radio" name="c_3" value="3" />Yes, and I DID see a doctor</p> <p>A skin rash?<br /></p> <p><input type="radio" name="c_4" value="1" />No</p> <p><input type="radio" name="c_4" value="2" />Yes, but did NOT see a doctor</p> <p><input type="radio" name="c_4" value="3" />Yes, and I DID see a doctor</p> <p>Shortness of breath?<br /></p> <p><input type="radio" name="c_5" value="1" />No</p> <p><input type="radio" name="c_5" value="2" />Yes, but did NOT see a doctor</p> <p><input type="radio" name="c_5" value="3" />Yes, and I DID see a doctor</p> <p>Chest pain?<br /></p> <p><input type="radio" name="c_6" value="1" />No</p> <p><input type="radio" name="c_6" value="2" />Yes, but did NOT see a doctor</p> <p><input type="radio" name="c_6" value="3" />Yes, and I DID see a doctor</p> <p>Headache?<br /></p> <p><input type="radio" name="c_7" value="1" />No</p> <p><input type="radio" name="c_7" value="2" />Yes, but did NOT see a doctor</p> <p><input type="radio" name="c_7" value="3" />Yes, and I DID see a doctor</p> <p>Fever?<br /></p> <p><input type="radio" name="c_8" value="1" />No</p> <p><input type="radio" name="c_8" value="2" />Yes, but did NOT see a doctor</p> <p><input type="radio" name="c_8" value="3" />Yes, and I DID see a doctor</p> <p>Acid indigestion or heartburn?<br /></p> <p><input type="radio" name="c_9" value="1" />No</p> <p><input type="radio" name="c_9" value="2" />Yes, but did NOT see a doctor</p> <p><input type="radio" name="c_9" value="3" />Yes, and I DID see a doctor</p> <p>Eye strain?<br /></p> <p><input type="radio" name="c_10" value="1" />No</p> <p><input type="radio" name="c_10" value="2" />Yes, but did NOT see a doctor</p> <p><input type="radio" name="c_10" value="3" />Yes, and I DID see a doctor</p> <p>Diarrhea?<br /></p> <p><input type="radio" name="c_11" value="1" />No</p> <p><input type="radio" name="c_11" value="2" />Yes, but did NOT see a doctor</p> <p><input type="radio" name="c_11" value="3" />Yes, and I DID see a doctor</p> <p>Stomach cramps (not menstrual)?<br /></p> <p><input type="radio" name="c_12" value="1" />No</p> <p><input type="radio" name="c_12" value="2" />Yes, but did NOT see a doctor</p> <p><input type="radio" name="c_12" value="3" />Yes, and I DID see a doctor</p> <p>Constipation?<br /></p> <p><input type="radio" name="c_13" value="1" />No</p> <p><input type="radio" name="c_13" value="2" />Yes, but did NOT see a doctor</p> <p><input type="radio" name="c_13" value="3" />Yes, and I DID see a doctor</p> <p>Heart pounding when not exercising?<br /></p> <p><input type="radio" name="c_14" value="1" />No</p> <p><input type="radio" name="c_14" value="2" />Yes, but did NOT see a doctor</p> <p><input type="radio" name="c_14" value="3" />Yes, and I DID see a doctor</p> <p>An infection?<br /></p> <p><input type="radio" name="c_15" value="1" />No</p> <p><input type="radio" name="c_15" value="2" />Yes, but did NOT see a doctor</p> <p><input type="radio" name="c_15" value="3" />Yes, and I DID see a doctor</p> <p>Loss of appetite?<br /></p> <p><input type="radio" name="c_16" value="1" />No</p> <p><input type="radio" name="c_16" value="2" />Yes, but did NOT see a doctor</p> <p><input type="radio" name="c_16" value="3" />Yes, and I DID see a doctor</p> <p>Dizziness?<br /></p> <p><input type="radio" name="c_17" value="1" />No</p> <p><input type="radio" name="c_17" value="2" />Yes, but did NOT see a doctor</p> <p><input type="radio" name="c_17" value="3" />Yes, and I DID see a doctor</p> <p>Tiredness or fatique?<br /></p> <p><input type="radio" name="c_18" value="1" />No</p> <p><input type="radio" name="c_18" value="2" />Yes, but did NOT see a doctor</p> <p><input type="radio" name="c_18" value="3" />Yes, and I DID see a doctor</p> <p></p><hr /> <p></p><center><input type="submit" value="---&gt; CLICK HERE TO SUBMIT &lt;---" /></center> </form>