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Men’s Health Survey

Please rate your quality of life in the following categories. Mark how you are now compared to how you were when you were younger:

1. Energy Level Poor Fair Good Great
2. Ability to Deal with Stress Poor Fair Good Great
3. Mental Focus Poor Fair Good Great
4. Motivation / Interest in Life Poor Fair Good Great
5. Creativity Poor Fair Good Great
6. Productivity Poor Fair Good Great
7. Physical Activity Level Poor Fair Good Great
8. Physical Strength & Balance Poor Fair Good Great
9. Sex Drive Poor Fair Good Great
10. Ability to Keep an Erection Poor Fair Good Great
What Is Your Age?