Health and Nutrition Survey Form

Health & Nutrition Survey Form

Full Name*

1. How often do you eat fruits and vegetables?

Every day3-4 times a week1-2 times a weekRarely

2. How many glasses of water do you drink daily?

Less than 4 glasses4-6 glasses7-9 glasses10 or more glasses

3. How often do you exercise?

Every day3-5 times a week1-2 times a weekRarely/Never

4. How would you describe your sleep quality?

ExcellentGoodAveragePoor

5. Do you take any dietary supplements?

Yes, dailySometimesRarelyNever