1. What is your age?

2. What country do you currently reside in?

3. Have you ever received a diagnosis of any mental illness or disorder? Yes

No

4. If yes, what was your diagnosis?

5. Are you currently diagnosed with any mental illness or disorder? Yes

No

6. If yes, what is your current diagnosis?

7. If yes, are you currently receiving treatment? Yes - drug therapy

Yes - talk therapy

Yes - both drug and talk therapy

Yes - other

No

8. What age do you believe you will live to? <20

20-30

30-40

40-50

50-60

60-70

70-80

80+

9. Give a brief description of where you see yourself in five years

10. Ten years?

11. Twenty Years?

12. How about fifty years?

13. On a scale of 1-5, with 1 being very difficult and 5 being very easy, how easy do you find it to set goals for your future?