Health and Wellness Survey

How old are you?

Do you drink alcohol?

1. Yes

2. No

Do you smoke cigarettes?

1. Yes

2. No

Are you pregnant or think that you may be?

1. Yes

2. No

Do you have a family doctor?

1. Yes

2. No

Have you ever done drugs?

1. Yes

2. No

How do you rate your health?

How many bowel movements do you have a day?

Do you have suffer from any chronic infections or diseasea?

1. Yes

2. No

Do you have diabetes?

1. Yes

2. No