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I have had a fruit in the last 24 hours
 
True
 
False
 
 
 
In the last 24 hours, I planned my meals.
 
Always
 
Most of the time
 
Half of the time
 
Never
 
 
 
In the last 24 hours I ate a food that was unhealthy (chips, fried foods, etc.)
 
True
 
False
 
 
 
In the last 24 hours, I chose a healthy snack from the vending machine
 
True
 
False
 
 
 
In the last 24 hours, I have participated in physical activity
 
True
 
False
 
 
 
How many physical activities have you participated in the past week?
 
One
 
Two
 
Three
 
Four
 
Five
 
 
 
How many servings of fruits and vegetables have you had in 24 hours?
 
One
 
Two
 
Three
 
Four
 
Five
 
 
 
Are you physically active by yourself, or a team? (one or more other persons)
 
Solo
 
Team
 
 
 
How many activities have you participated in the past week?
 
One
 
Two
 
Three
 
Four
 
Five
 
 
 
Are you likely to participate in physical activities daily, weekly, or monthly?
 
Daily
 
Weekly
 
Monthly
 
Other
 
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