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  1. Surveys
  2. 2012
  3. July
  4. K
  5. Kamp Shape Up
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Hello:
You are invited to participate in our survey How Healthy Are You?. In this survey,approximately 500 people will be asked to complete a survey that asks questions about overall health and wellness habits. It will take approximately 3 minutes to complete the questionnaire.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact DeAnn Teixeira by email at the email address specified below.

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.
 
 
 
* What is your date of birth?
 
 
 
* Choose One:
 
Male
 
Female
 
 
 
* Enter your weight in pounds:
   
 
 
 
* Height: Feet
   
 
 
* Inches
   
 
 
 
* Waist measurement (inches):
 
Female below 35 inches
 
Female 35 inches & above
 
Male below 40 inches
 
Male 40 inches & above
 
 
 
* Primary Goal: (Choose One)
 
Weight Loss
 
Muscle Gain
 
Improved Health
 
Increase Energy
 
Other
 
 
 
 
* Medical history: Has your doctor diagnosed you with a condition listed below? (May choose more than 1)
 
High Blood Pressure
 
High Cholesterol
 
Diabetes
 
No medical conditions
 
Other
 

 
 
 
* Choose the answers that relate to your lifestyle:
 
Not enough sleep (less than 7 hours each night on average)
 
Poor eating habits (large portions, junk food junkie, skip meals)
 
Little or no exercise (less than a total of 60 minutes of heart pounding exercise each week)
 
Diet addict ( tried more than 1 food restrictive programs, lost and gained weight repeatedly)
 
None, I feel I live with very healthy lifestyle habits
 
Other lifestyle habits you feel need improvement?
 

 
Thank you from Kamp Fitness. Your time is much appreciated!
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