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how physically healthy are you?
 
moderately healthy
 
very healthy
 
slightly healthy
 
extremely healthy
 
not at all healthy
 
 
 
Do you take nutritional supplement?
 
yes
 
No
 
 
 
How important is exercise to you?
 
extremely important
 
very important
 
moderately important
 
slightly important
 
not at all important
 
 
 
what do you most often for exercise?
 
Lift weights
 
walk
 
run
 
hike
 
swim
 
dance
 
aerobics
 
pilates
 
play a team sport
 
Other
 
 
 
 
Do you feel you get too much exercise, too little exercise, or about the right amount of exercise?
 
much too much
 
somewhat too much
 
slightly too much
 
about the right amount
 
slightly too little
 
somewhat too little
 
much too little
 
 
 
In a typical day, how many of your snaks or meals include carbohydrates?
 
 
 
 
 
 
In a typical day, how many of your meals and snacks include protein?
 
 
 
 
 
 
In a typical day how many of your meals and snacks include fruit?
 
 
 
 
 
 
in a typical day how many microwavable or ready-made meals do you eat?
 
 
 
 
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