JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Women Putting Their Wellness First
Help us understand how we can support you better in putting your health first.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Gender:
Female
Male
Other
Clear selection
Age:
13-17
18-24
25-34
35-49
50-69
70+
Clear selection
What does wellness mean to you?
Your answer
How important is your wellness to you?
It's the least important thing
1
2
3
4
5
6
7
8
9
10
It's the most important thing
Clear selection
Over the last 12 months would you say your health has been?
Very good
Fairly good
Not very good
Not good at all
Clear selection
How would you rate your quality of life in relation to your emotional well-being?
Very good
Fairly good
Not very good
Not good at all
Clear selection
Which of the following have you had issues with?
Addiction
Anxiety
Autoimmune health
Birth Control
Cardiovascular health
Depression
Eating Disorder
Female hormones
Fertility
Metabolic health
Menopause
Menstruation
Motherhood
Pregnancy
Sexual health
Sexuality
Stress
UTIs
Other:
Have you ever sought help to improve your well-being?
Yes
No
Clear selection
If yes, where does your search for support start?
Friends and Family
Google
YouTube
Instagram
Facebook
Medium
Medical professional (i.e. primary care or GP)
Blogs
App Store
Other:
Clear selection
Please select the type of support you are looking for
Advice
Connection with a health professional with specific expertise
Finding people with similar challenges/issues
Other:
Clear selection
Can you tell us about some of the most supportive social profiles or online blogs/communities that you follow/are apart of?
Your answer
What support do you, and other women you know, need more of?
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms