1. I have clear, written goals for my non-work life.

Yes
Sort of
Hah

2. I spend adequate time with family members outside my own household.

Not at all
Plenty of time

3. I rely on medications to get me "through".

Most of the time
Never

4. I feel I have a good balance between work, friends, family and myself.

Very balanced
Somewhat balanced
No balance

5. I am pleased with my physical appearance.

Not really
Yes, I am

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