This free survey is powered by QUESTIONPRO.COM
0%
Exit Survey »
 
 
How often are you physically active on a weekly basis?
 
one to two times
 
three to four
 
five to seven
 
Other
 
 
 
 
How long do you exercise per day?
 
less than 30 minutes
 
30 to 60 minutes
 
60 to 90 minutes
 
greater than 90 minutes
 
 
 
What types of exercises do you participate in (Select all that apply)?
 
Cardiovascular
 
Flexibility
 
Muscular Endurance
 
Strength and Resistance
 
Balance and Coordination

 
 
 
What exercises are you willing to participate in(Select all that apply)?
 
Running
 
Swimming
 
Hiking
 
Biking
 
Roller Blading
 
Yoga
 
Kayaking
 
Other
 

 
 
It is important to be physically active 3 times a week or more?
Strongly Disagree Disagree Neutral Agree Strongly Agree
 
 
 
 
How often do you eat junk food (foods that are high in fat and sugar)?
 
never
 
rarely
 
often
 
all the time
 
 
 
On a regular basis, how much vegetables do you eat during the day?
 
less than 1 cup
 
1 to 2 cups
 
2 to 3 cups
 
greater than 3 cups
 
 
 
On a regular basis, how much fruit do you eat daily?
 
less than 1 cup
 
1 to 2 cups
 
2 to 3 cups
 
greater than 3 cups
 
 
 
What food groups do you eat on a regular basis (Select all that apply)?
 
Fruits
 
Vegetables
 
Grains
 
Protein Foods
 
Dairy
 
Oils

 
 
Eating a well-balanced meal is important to one's health.
Strongly Disagree Disagree Neutral Agree Strongly Agree
 
 
Survey Software Powered by QuestionPro Survey Software