What are your Habit?

How important is your eating habits?

Very Important

Moderately Important

Slightly Important

Not at all Important

Do you take nutritional supplements?

Yes

No

How often do you eat?

Once a day

Twice a day

Three times a day

More than 3x a day

DO you pay attention to making healthy food choices when you eat?

Always pay attention

Frequently pays attention

I sometimes pay attention

How do YOU describe your health?

What is your gender?

Male

Female

Do you eat everyday?

Yes

No

Do you eat fruits and vegetables?
If so, hoe often?

Yes

No

Explain

What age group are you in?

18-25

26-35

36-45

55 and older

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Yes

No