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Diet quiestionairre

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Questionnaire What is your gender? Male ? Female ? Into which age category do you fit? 11-15 ? 16-20 ? 21-30 ? 31-40 ? 41-50 ? 51-60 ? 60+ ? How much do you weigh? 40-60 KG ? 61-80 KG ? 81-100 KG ? 101-120 KG ? 121-140 KG ? 141-160 KG ? 161 KG+ ? How tall are you? ____Ft Do you have a disability? Yes ? No ? Describe in your opinion what being healthy is? How would you describe your current health on a scale of 1-10; 1 being poor and 10 being excellent? How would you describe your current health? I don't eat well enough or do enough exercise ? I feel ok with my diet and exercise ? ...read more.


Do you wear glasses for sport? Yes ? No ? How do you think a person benefits from exercising? Yes ? No ? __________________________________________________________________________________________________(State why) Are you on any type of diet to help improve your weight? E.g. vegetarian Do you smoke? If yes please state how many cigarettes a day Yes ? No ? Please State ___________ Do you suffer from any illness? Yes ? No ? ________ (If yes please mention) Do you eat five portions of fruit and veg. every day? Yes ? No ? Do you regularly monitor your weight? Yes ? No ? ________(If yes, state how often) Do you drink alcohol? If yes how many units per week (leave blank if you don't drink) Yes ? No ? ...read more.


What specific diet plan do you follow? How often do you eat meat? How do you see yourself in terms of body type: Obese, Fat, Average, Athletic, Slim or Anorexic? Do you wear glasses or corrective lenses, if so what for, short/long distance? Do you take any illegal substances, if so which and if not have you ever tried any? How do you usually get around e.g. car or walk? How far do you travel to work/ place of study? _____ Miles What are your hobbies? How much time do you spend outdoors? ________ Hours per day How would you rate your hygiene on a scale of 1 to 10, with 10 being extremely clean, And why? Can you walk briskly for a mile without getting out of breath? Yes ? No ? ?? ?? ?? ?? Fahmi Ally Physical Education ...read more.

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