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What is your favorite color?
 
Black
 
White
 
Blue
 
Yellow
 
Red
 
Green
 
Purple
 
Orange
 
Other
 
 
 
 
What is your gender?
 
Male
 
Female
 
 
 
What is your favorite meal course?
 
Appetizer
 
Salad
 
Soup
 
Entree
 
Dessert
 
Just drinks
 
 
 
What is your height range?
 
Under 5 feet
 
5-6 feet
 
Over 6 feet
 
 
 
Do you wear socks?
 
Yes
 
Sometimes
 
No
 
 
 
What is your favorite season?
 
Winter
 
Spring
 
Summer
 
Fall
 
 
 
What is your favorite food group?
 
Grains and Carbohydrates
 
Fruits and Vegetables
 
Dairy and Eggs
 
Sugars and Fats
 
 
 
What is your preferred means of communication?
 
In person
 
By phone
 
Text message
 
Email
 
Online chat
 
 
 
Email Address
   
 
 
 
ZIP code
   
 
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