How healthy are you?
How would you rate your lifestyle?
Very healthy
Not healthy enough
Very unhealthy
Do you smoke?
Never
1-3 Cigarettes a day
3-10 Cigarettes a day
More than 10 cigarettes a day
Do you drink alcohol?
Occasionally or never
1-2 glasses a day
3 or more glasses a day
Do you have cholesterol problems?
Yes
No
How often do you have a medical check?
Never or almost never
When ill
Once a year
How many servings of fruit and vegetables do you eat a day?
4 or more
3
2
1
What kind of drinks do you drink daily (apart from coffee or tea)?
Water
Fruit juice
Soda drinks
How much sugar do you have?
I have chocolates and eat sweet treats often
I eat mainly processed foods (high in sugar)
I try to follow a low added-sugar diet
I do not have any added sugar
Do you prepare your own food?
Yes, almost always
No, I mainly eat processed food
I eat outside, healthy food mostly
I eat outside, fast food mostly
Would you like to learn about healthy food and how to prepare it?
Yes
No
Do you exercise daily?
More than 60 minutes a day
30-60 minutes a day
Less than 30 minutes a day
30 minutes a few times per month
Rarely
Do you get enough sleep each night?
More than 8 hours
7-8 hours
Less than 7 hours
Do you have difficulty getting to sleep?
Rarely or never
Sometimes
Very often or always
Do you take any time to relax quietly or meditate?
Yes
No
How much time do you spend watching tv?
Less than 1 hour a day
1-3 hours a day
More than 3 hours a day
How do you rate your stress level?
Low
Medium
High
Are you satisfied with your job situation?
Yes, totally
Not really
Not at all
Are you satisfied with your familiar/social situation?
Yes, totally
Not really
Not at all
Would you like to receive advice about lifestyle choices to reduce stress and live happier?
Yes
No
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