1. Do you live in Co.Sligo, Ireland?

yes

no

part time

2. What age bracket are you?

18-30

30-50

50-70

70+

3. How often do you feel that you lack companionship?

Never

Rarely

Sometimes

Always

4. How often do you feel alone?

Never

Rarely

Sometimes

Always

5. How often do you feel that you are no longer close to anyone?

Never

Rarely

Sometimes

Always

6. How often do you feel left out?

Never

Rarely

Sometimes

Always

7. How often do you feel that no one really knows you well?

Never

Rarely

Sometimes

Always

8. How often do you feel that people are around you but not with you?

Never

Rarely

Sometimes

Always