Are You Healthy Survey?
Answers marked with a * are required.
 
 
1. Do you consider yourself: *
      
 
 
 
2. Is obesity a concern in your community? *
      
 
 
 
3. Are efforts being made in community schools to improve the nutritional quality? *
      
 
 
 
4. Are you involved in an effort to improve you/your family's eating habits? *
      
 
 
 
5. Are you involved in an effort to improve you/your family's physical activities? *
      
 
 
 
6. I think the primary cause of childhood obesity is due to: *
      
 
 
 
7. Should schools be permitted to sell soda or "junk food"? *
      
 
 
 
8. Should physical education be part of school cirriculums throughout all grade levels? *
      
 
 
 
9. Would you participate in after school/after work group physical activity programs if offered? *
      
 
 
 
10. If so, which type of activities would you like to participate in? *
      
 
 
 
11. How would you like to receive information regarding healthy lifestyle guidelines? *
      
 
 
 
 
 

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