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2016
March
P
Pre-Hydration Challenge Survey
Pre-Hydration Challenge Survey
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Please enter your code name as your middle initial and last 4 digits of your cell phone number. Ex: Lisa Ann P= A9730
Weight (pounds)--As of the Week of March 7th 2016---
*
Please rank (1-7) the following in order of beverage choice with one being your preferred number one choice:
Juice
-- Select --
1
2
3
4
5
6
7
Gatorade or Powerade
-- Select --
1
2
3
4
5
6
7
Coffee
-- Select --
1
2
3
4
5
6
7
Water
-- Select --
1
2
3
4
5
6
7
Soda (Diet or non-diet)
-- Select --
1
2
3
4
5
6
7
Tea (Sweetened or unsweetened)
-- Select --
1
2
3
4
5
6
7
Energy Drinks
-- Select --
1
2
3
4
5
6
7
How many glasses of water do you estimate you drink per day?
One cup (8 oz.) or less
16 oz. (2 cups)
32 oz. (4 cups)
More than 8 cups (64 oz.)
Other
What influences your choice of beverage the most?
Taste/Flavor
Mood or How your Feeling
Cost
Availability
Other
What do you think is going to be the most difficult part of the hydration challenge?
Documenting intake
Limiting/replacing sugary beverage choices (soda, sweet tea)
Figuring out measurements
Availability of healthy choices
Other
Do you read Nutrition facts labels on beverages?
Yes
Sometimes
No
What can Extension do to help you be more successful in your health goals?
What other "challenges" or health related activities would you like to see in the Unit?
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