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How good do you feel about your nutritional choices?
 
Really Good
 
Good
 
Neutral
 
Bad
 
Really Bad
 
 
 
What meat do you most commonly eat?
 
Beef
 
Chicken
 
Pork
 
Fish
 
None (Vegetarian)
 
None (Vegan)
 
Other
 
 
 
 
How often do you eat sweets? (Chocolate, candy, cake, etc...)
 
Daily
 
Weekly
 
Monthly
 
Quarterly
 
Annually
 
 
 
How often do you eat vegetables?
 
Daily
 
Weekly
 
Monthly
 
Quarterly
 
Annually
 
 
 
Do you keep track of how much calories or sugar you eat?
 
Yes
 
No
 
 
 
Do you consider yourself in a generally good state of physical fitness?
 
Yes
 
No
 
 
 
Do you consider yourself to be in a generally good state of mental fitness?
 
Yes
 
No
 
 
 
How often do you exercise?
 
Daily
 
Weekly
 
Monthly
 
Quarterly
 
Annually
 
Other
 
 
 
 
How happy are you in general? (Yes, this is a serious question.)