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  1. Surveys
  2. 2013
  3. October
  4. H
  5. Health Awarness Survey
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Hello:
You are invited to participate in our survey on Health Awareness. In this survey, approximately100 people will be asked to complete a survey that asks questions about General Awareness of factors influencing Health. It will take approximately 5- 8 minutes to complete the questionnaire.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact Mr Vazirani at =91-983-341-6599 or by email at [email protected]
Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.

 
 
 
 
Name:
   
Age:
   
Gender:
   
Contact Number::
   
 
 
 
Could you describe your lifestyle?
 
Stressed
 
Active
 
Normal
 
Other
 
 
 
 
Do you have a felling of fatigue or weariness at the end of the day?
 
Yes
 
No
 
Other
 
 
 
 
Do you or any of your family members suffer from the diet related problems? which could lead to Cardio-vascular, Hyper-tension(Blood Pressure), Elevated levels of Blood Sugar levels and etc....
 
Yes
 
No
 
if any problem persists
 
Other
 
 
 
 
How would put your weight to be right of now?
 
Ideal
 
Over-weight
 
Under-weight
 
Other
 
 
 
 
Do you think and Believe the extra - weight (Obesity) is an risk factor for Cardio Vascular, Elevated Blood Sugar Levels (Diabetes), hypertension (Blood Pressure), certain types of cancers and etc?
 
Yes
 
No
 
Other
 
 
 
 
Are you interested in knowing about Good Nutrition and understanding yourself better by getting a FREE Body Fat Analysis and Consultation for yourself and your family?
 
Yes
 
No
 
Other
 
 
 
 
If your answer is yes to the above question, What is the most convenient time to contact you?
   
 
We would like to thank you for your participation and the time given by you in this survey. Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact Mr Vazirani at =91-983-341-6599 or by email at [email protected].