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How many times per week do you eat in fast food restaurants?
 
Once
 
Twice
 
Three times
 
Every day
 
 
 
How many times per week do you work-out?
 
At least once
 
Twice
 
Every day
 
Never
 
 
 
How many bottles of water do you drink per day?
 
Once
 
More than one
 
Several
 
None
 
 
 
In general, would you say your health is:
 
Excellent
 
Very Good
 
Good
 
Fair
 
Poor
 
 
 
I avoid eating foods that are high in calories and fat
 
Always True
 
Frequently True
 
Never True
 
 
 
Do you play sports?
 
YES
 
NO
 
 
 
How old are you?
 
10-13
 
14-16
 
17-18
 
Prefer not to answer
 
Other
 
 
 
Do you eat organic foods?
 
Yes
 
No
 
Sometimes
 
 
 
Do you ever diet?
 
Yes
 
No
 
 
 
Do you keep track of your calorie intake?
 
Yes
 
No
 
Sometimes