Health and fitness questionnaire survey
Scan QR Code
Your information will be kept confidentially and will not be used for 3rd parties.
Remaining
*
1.
To which gender identity do you most identify
Male
Female
Not listed
Prefer not to answer
*
2.
How old are you?
0-15
16-20
21-25
26-35
36-40
above 40
3.
What is your current weight in kilogram (kg)?
*
4.
What is the highest degree or level of school you have completed
No schooling completed
High school graduate, diploma or the equivalent
Some college credit, no degree
Bachelor’s degree
Master’s degree
Professional degree
Doctorate degree
Others
*
5.
Are you currently ...?
Employed for wages
Self-employed
Out of work and looking for work
Out of work but not currently looking for work
A homemaker
A student
A military
Retired
Unable to work
*
6.
If you are currently working, what is your job role, and what is your title?
Please write down
Skip this question
*
7.
What is your annual salary (in Australian dollar)?
Below 30,000
30,000 - 40,000
40,001 - 50,000
50,001 - 60,000
60,001 - 70,000
70,001 - 80,000
above 80,000
*
8.
Please specify your family status
Married
Living with partner
Single
Others
*
9.
How many children do you have
Please write down
I'm pregnant now
*
10.
Where do you live? Please write down the suburb you live in.
*
11.
How often do you take exercise?
Not at all
less than 5 hours a week
6- 10 hours a week
more than 10 hours a week
*
12.
Do you prefer eat outside or at home?
Eat outside
At home
13.
What are your favourite foods? Please list below.
*
14.
Do you want to lose weight?
Yes
No
*
15.
Do you worry about unhealthy foods?
Yes
No
Not sure
Evaluation object score
(?)
A.男
B.女
问卷正在加载中，请稍候...
如果由于网络原因导致此框一直不消失，请重新刷新页面！
Powered By
www.wjx.cn
