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HEALTHY LIFE SURVEY
What is your gender?
- Male
- Woman
- Other (please specify)
Your age?
- 18-24
- 25-34
- 35-44
- 45-54
- 55-64
- 65 and above
How many days a week do you exercise?
- I never do
- 1-2 days
- 3 or 4 days
- 5 or more days
What activities do you prefer while exercising? (You can tick more than one option)
- Walk
- Running
- Cycling
- Yoga/Pilates
- Fitness/Weight training
- Swimming
- Other
Please specify
How many servings of fruits and vegetables do you consume daily?
- I never consume
- 1-2 servings
- 3-4 servings
- 5 or more servings
How many meals do you eat a day?
- 1 meal
- 2 meals
- 3 meals
- 4 meals or more
How long do you prefer to sleep per day?
How would you describe your eating habits?
How many glasses of water do you drink a day?
- I don't drink at all
- 1-2 glasses
- 3-4 glasses
- 5 or more glasses
Do you smoke?
-Yes
-No
Do you consume alcohol? If yes, how many days a week do you consume alcohol and how much alcohol do you drink on average?
What kind of foods do you consume on a daily basis?
How important is it for you to live a healthy life?
What activities do you prefer while exercising? (You can tick more than one option)
- Balanced diet
- Doing regular exercise
- Avoiding stress and practicing relaxation techniques (e.g. meditation, breathing exercises)
- Getting enough sleep
- Not smoking
- Limiting alcohol consumption
- Performing health checks regularly
- Other
Please specify
What techniques do you use for stress management? (You can tick more than one option)
- Yoga/Meditation
- Doing sports
- Take a deep breath
- Don't bother with hobbies
- Spending time with friends or family
- Getting professional help (therapy, counseling)
- Other
Please specify
How often do you have your health check-ups?
- Once a year
- Once every two years
- Regularly, every six months
- I rarely or never have it done
What are your goals regarding healthy living?
Is there anything you would like to add about healthy living?
Submit