| 1. Rate your contentment with society and
the world from 1 to 10, where one is extremely contented and 10 is extremely discontented. |
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| 2. How many hours per week do you spend in
a creative activity (music-making, painting, writing, gardening, carpentry, etc.)? |
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| 3. How many hours per week do you spend in
a church, temple, mosque, synagogue, etc.? |
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| 4. How many hours per week do you spend in
a car? |
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| 5. How many hours per week do you spend at
a computer? |
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| 6. If you smoked only one joint last week,
write zero; if you smoked several, then give yourself 2 points here for each joint more
than one. |
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| 7. How many hours did you spend visiting
an art museum last month? |
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| 8. How many times per week do you laugh
heartily and happily? |
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| 9. How many hours did you spend nurturing
animals or plants last week? |
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| 10. How many hours did you spend nurturing
another person (child-rearing, caring for the sick, teaching. etc.) last week? |
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| 11. Each week, how many nights do you NOT
remember any dreams on awakening? |
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| 12. Divide the amount of money in dollars
you gave anonymously to charity last year by 100 and write the number: |
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| 13. How many hours do you watch TV each
weekend day? |
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| 14. How many dreams do you write down on
the average morning? |
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| 15. How much caffeine do you consume daily
(1 point for each cup of coffee or tea, 1 point for each soft drink with caffeine)? |
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| 16. How many hours per week do you spend
shopping for items other than food? |
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| 17. How many out-of-body experiences have
you had? |
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| 18. How many poems did you read in the
last week? |
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| 19. On a scale of 0 to 10, where 0 is
blissful, 10 is despondent, rate your average emotional state. If your emotional state
varies widely, write 10. |
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| 20. How many hours did you listen to talk
radio last week? |
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| 21. How many Prozacs, Valium, Viagra, or
other mood-altering or psychoactive pills did you take last week? |
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| 22. How many times did you get angry last
week? |
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| 23. How often in the last six months have
you taken LSD, psylocybin, mushrooms, peyote, etc.. |
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| 24. How many shots/glasses/cans of any
drink containing alcohol more than one a day did you have last week? |
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| 25.Give yourself 1 point for each hug you
gave or received in the last week. |
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| 26. Give yourself 10 points for each hour
you spent listening to Rush Limbaugh last week. |
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| 27. How many near-death experiences,
encounters with ghosts, or UFO experiences have you had in your life? |
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| 28. How many hours per week do you spend
in some form of mass transit? |
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| 29. Rate your contentment with your
position in society and the world from 0 to 10, where 0 is extremely discontented and 10
is extremely contented. |
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| 30. Each week, how many days do you spend
NO time either sitting or walking outdoors? |
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| 31. How many hours per week do you spend
listening to any kind of music written before 1900? |
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| 32. How many children, other than your
own, did you hug last week? |
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| 33. How many packs of cigarettes did you
smoke last week? |
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| 34. How many servings of meat did you eat
last week? (One meal with a meat dish = one serving.) |
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| 35. Approximately how many spoons or
packets of sugar or sweetener do you consume each day? |
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| 36. How many gallons of gas did you put in
your car last week? |
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| 37. How many times did you feel depressed
last week? |
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| 38. How many times have you struck a child
in your life? |
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