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Describe yourself:
Under 19 20-29 30-39 40-49 50-59 Over 60
Male
Female
 
 
 
What is your professional status?
 
Student
 
Full time Employee
 
Part-time/Seasonal Employee
 
Self-Employed
 
Business Owner
 
Unemployed
 
 
 
What is your annual income?
 
Less than $30,000
 
$30,000 - $59,999
 
$60,000 - $89,999
 
$90,000 - $119,999
 
$120,000 and over
 
 
 
Where do you currently reside in the GTA?
 
Toronto
 
Mississauga
 
North York
 
Scarborough
 
Etobicoke
 
Brampton
 
Markham
 
Richmond Hill
 
Other
 
 
 
 
Do you currently have group or personal health insurance?
 
No
 
Yes (Group or Personal)
 
 
 
 
In general, how would you rate your health?
 
Excellent
 
Very Good
 
Good
 
Fair
 
Poor
 
 
 
Why do you think maintaining a healthy lifestyle is important?
 
Live longer
 
Reduce risk of diseases
 
Being happier
 
Looking and feeling better
 
Other
 

 
 
Of these services, specify your number of visits per year or if you are interested:
Number of Visits Interested
Counseling Services
Life Coach
Fitness Center
Aromatherapy
Chiropractic
Homeopathy
Massage Therapy
Naturopath
Nutritionist
Osteopathy
Physiotherapist
Traditional Chinese Medicine (Acupuncture or Herbal Remedies)
 
 
 
For services that you did not try, what prevented you from it?
 
Lack of time
 
Lack of money
 
Lack of information
 
Lack of motivation
 
Not interested
 
Other
 

 
 
 
What would motivate you to frequent these services more often?
 
Discounts
 
Understanding the benefits
 
Community of like minded individual to share experiences
 
Convenient access to these services
 
Other
 

 
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