Skip to content
Diet & Exercise Template
1.
How physically healthy are you?
Not at all healthy
Extremely healthy
Clear
2.
Do you take nutritional supplements?
Yes
No
3.
How important is exercise to you?
Not at all important
Extremely important
Clear
4.
What do you most often do for exercise?
Lift weights
Walk
Run
Hike
Swim
Dance
Aerobics
Pilates
Play a team sport
Other (please specify)
5.
Do you feel you get too much exercise, too little exercise, or about the right amount of exercise?
Much too little
The right amount
Much too much
Clear
6.
In a typical day, how many of your meals or snacks include carbohydrates?
7.
In a typical day, how many of your meals or snacks include protein?
8.
In a typical day, how many of your meals or snacks include vegetables?
9.
In a typical day, how many of your meals or snacks include fruit?
10.
In a typical day, how many microwavable or ready-made meals do you eat?
Current Progress,
0 of 10 answered