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Questions marked with a * are required Exit Survey
 
 
Name
   
 
 
 
* Age
 
<2
 
2-10
 
11-20
 
21-30
 
31-40
 
40-50
 
>50
 
 
 
* Gender
 
Male
 
Female
 
Other
 
 
 
Profession
   
 
 
 
* City where you live in
 
 
 
Exact location
   
 
 
 
* Marital status
 
Married
 
Unmarried
 
 
 
How many children do you have ?
   
 
 
 
* Height
 
< 3
 
3-4 feet
 
4-5 feet
 
5-6 feet
 
>6
 
 
 
* weight (in Kilograms)