This free survey is powered by QUESTIONPRO.COM
0%
Exit Survey »
 
 
Are you health conscious when it comes to food?
 
Yes
 
No
 
 
 
Do you eat at Fast Food Restaurants?
 
Yes
 
No
 
 
 
How important are the following dietary concerns when choosing your food?

Reducing Fats and Cholesterol
Weight control
Disease / cancer fighting
 
Not important
 
Somewhat important
 
Netural
 
Very important
 
Other
 
 
 
Please rate your overall physical health relative to other people your own age?

 
Poor
 
Fair
 
Good
 
Very Good
 
Excellent
 
Other
 
 
 
How often do you participate in at least 30 minutes of exercise?


 
Less than once a week
 
1-3 times a week
 
4-7 times a week
 
More than 7 times a week
 
 
 
How many glasses of water do you drink per day?

 
0-1 glass
 
2-4 glass
 
6-8 glass
 
1-3 times per week
 
Almost never
 
 
 
What is your combined household income?

 
Less than $10,000
 
$10,000 to $25,000
 
$30,000 to $50,000
 
$60,000 to $100,000
 
150,000 or more
 
Decline to answer
 
 
 
What is your highest level of education
 
Elementary
 
High School
 
Graduate
 
Post Graduate
 
Not willing to share
 
 
 
What is your gender?
 
Male
 
Female
 
 
 
In your opinion, what is a healthy lifestyle? Describe it?


 
____________________________________________________________________
 
 
____________________________________________________________________
 
 
____________________________________________________________________
 
 
____________________________________________________________________
 
 
____________________________________________________________________
 
Survey Software Powered by QuestionPro Survey Software