iPad Form Design

In an attempt to keep things natural and as simple as possible, I've decided to try and design a simple yet interesting layout for the survey that modifies the rest of the piece.

I'm currently working on the idea that the survey will be conducted on an iPad that is fixed in front of the three computer screens. The user will be asked questions and will be provided with a selection of buttons to press to enter their answers. Here is an in-progress example:

I was trying to keep the interface as interesting as possible without making it too busy. I am also doing research into what questions to ask, trying to keep mainly in the realm of daily activities. I also want to have as little text as possible, but I don't want the answers to be too confusing.