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Questions marked with a * are required Exit Survey
 
 
* Your Name
   
 
 
 
* Gender
 
Male
 
Female
 
 
 
* Age
   
 
 
 
* Phone
   
 
 
 
* E-mail Address
   
 
 
 
* Do you consider yourself active?
 
Yes
 
No
 
 
 
* How many days per week do you partake in physical activity?
 
Never
 
1-2x/week
 
3-4x/week
 
5-7x/week
 
 
 
* Normally I eat (daily):
 
1 meal or less
 
2-3 meals
 
4-6 meals
 
 
 
* Do you take vitamins or supplements?
 
Yes
 
No
 
 
 
If you answered yes to the last question, list below what you are taking.