Fall into a Healthier You
1.
What motivated you to sign up for the HeathyU research project?
Monetary compensation
Unhealthy lifestyle
Social or emotional issues
Weight issues
Medical issues
Other (please specify)
2.
Has anyone ever recommended that you lose weight or change your eating habits?
Yes
No
3.
Do you use recreational drugs?
Yes
No
Prefer not to answer
4.
Have you ever felt that you should cut down on your alcohol consumption?
Yes
No
5.
Do you smoke cigarettes or vape?
Yes
No
6.
Have you had panic or anxiety attacks?
Yes
No
7.
Do you feel safe at home, school, or in general?
Yes
No
8.
Are you interested in working with someone for additional help?
Nutritionist
Health Services
Counseling Center
Learning for Life
Recreational Center
*
9.
Please provide your name and email address so we can contact you with Zoom information for our first session on October 10th.
(Required.)
