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Survey;
Instructions Be honest!
1) Name
) Age
) Sex
4) Location
5) In general, what would you say your health is? (Please circle)
·Excellent
·Very Good
·Good
·Fair
·Poor
6) What are some unhealthy things you do?
7) Are you a cigarette smoker?
8) Do you drink alcohol?
) What do you believe leading a healthy lifestyle would include?
10) If you need to get some help with your health, what would you do?
11) Do you believe you can improve on your health at your current age? Why/why not?
1) What are the benefits of being healthy?
1) During the past week, have you had any pains in any parts of your body?
A)Yes
B)No
14) As you get older, do you expect your health to get worse? Do you believe you can improve/prevent your health from getting worse? Explain how.
15) From question 14. The question states 'can you improve/prevent your health from getting worse.' If you answered yes, do you actually do this or just wrote it because you know it is right?
16) If you went to work by train and the train station is 5 minutes walking distance from your home. Would you walk to the station, catch public transport, or go by car?
17) How would you best classify your health under these three categories?
a)Your health only consists of your physical state.
b)Your health is a continually changing condition.
c)Your health is totally determined by your genetic make-up.
18) Do you watch T.V more than hours a day? If it is more, please start approximately how much?
1) When is T.V mostly watched, please tick
·Morning
·Afternoon
·Night
0) If you could improve 1 health area in yourself what would it be?
1) If you were at home and there had been no food prepared for you. Would you rather eat McDonalds or make a salad sandwich from home. Why? (Example Is it financially better, health reasons, taste reasons?)
) Do you believe you are (circle)
a)Underweight
b)Overweight
c)Obese
d)Average/Normal
) Calculate you BMI (Body Mass Index). Do this by your weight (kg) divided by your (height) (m)
(For example If you weigh 80kg and your hight is 1.75m. Your BMI would be 80 divided by (1.75) =6.1). Please circle which category you full under
·Below 18.5
·18.5 - 4.
·5 - .
·Above 0
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