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Name
   
 
 
 
Hometown
   
 
 
 
Are you satisfied with your current body weight?
 
Yes
 
No
 
 
 
How often do you eat Fast Food (such as MCD, KFC, A&W, ETC)
 
Always (>5 times / WEEK)
 
Often (>2 times / WEEK)
 
Seldom (>2 times / MONTH)
 
Never
 
 
 
How often do you drink softdrink?
 
Always (>5 times / WEEK)
 
Often (>2 times / WEEK)
 
Seldom (>2 times / MONTH)
 
Never
 
 
 
How often do you eat at restaurant?
 
Always (>5 times / WEEK)
 
Often (>2 times / WEEK)
 
Seldom (>2 times / MONTH)
 
Never
 
 
 
Which device are you use more often?
 
Mobile
 
Tablet (ipad, galaxy tab, etc)
 
Computer
 
 
 
Which OS (Operating System) are you using?
 
IOS (apple)
 
Android
 
Windows
 
Symbian
 
Other
 
 
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