Diet & Exercise Template

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* 1. How physically healthy are you?

Not at all healthy

Extremely healthy

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 2. Do you take nutritional supplements?

Yes

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* 3. How important is exercise to you?

Not at all important

Extremely important

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 4. What do you most often do for exercise?

Lift weights

Walk

Run

Hike

Swim

Dance

Aerobics

Pilates

Play a team sport

Other (please specify)

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* 5. Do you feel you get too much exercise, too little exercise, or about the right amount of exercise?

Much too little

The right amount

Much too much

Clear

i We adjusted the number you entered based on the slider’s scale.

Diet & Exercise Template

Question Title

* 1. How physically healthy are you?

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* 2. Do you take nutritional supplements?

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* 3. How important is exercise to you?

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* 4. What do you most often do for exercise?

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* 5. Do you feel you get too much exercise, too little exercise, or about the right amount of exercise?

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* 6. In a typical day, how many of your meals or snacks include carbohydrates?

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* 7. In a typical day, how many of your meals or snacks include protein?

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* 8. In a typical day, how many of your meals or snacks include vegetables?

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* 9. In a typical day, how many of your meals or snacks include fruit?

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* 10. In a typical day, how many microwavable or ready-made meals do you eat?