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How many soft drinks do you drink daily?
 
0-1
 
2-4
 
4-6
 
6+
 
 
How often do you incorporate the healthy food choices into your diet
None Very little Average A lot of the time All of the time
Vegetables
Fruits
Proteins
Grains
 
 
 
How often do you take vitamins?
 
Never
 
Weekly
 
Monthly
 
Annually
 
 
 
How many meals do you eat in a day?
 
1
 
2
 
3
 
4+
 
 
 
What types of foods are in your daily diet
 
Chips
 
Snack cakes
 
Fried foods
 
Bake goods
 
Salads
 
Other
 

 
 
 
Please drag and rank(1st to 3rd) the following in order of interest:
Drag your choices here to rank them
     
     
     
    How many cups of water do you drink daily?
     
    None
     
    1-2
     
    2-3
     
    4-5
     
    6+
     
     
     
    How often do you smoke including marijuana?
     
    Never
     
    Daily
     
    Weekly
     
    Monthly
     
    Yearly
     
     
     
    Do you have
     
    Good hygiene
     
    Safe sex
     
    A balanced diet

     
     
     
    If you had the choice which would you rather drink at lunch?
     
    Milk
     
    Water
     
    Other