Exit survey
Health Survey
Completion Status:----------

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Please select your gender:


Please select which applies to you:
YesNo
Do you drink?
Do you smoke?
Are you overweight?
Are you diabetic?
How often do you take part in the following activities?
Daily3xs/week2xs/weekOnce a weekTwice a monthMontlyN/A
Walking
Running/Jogging
Swimming
Cycling
Rollerbladding
Aerobics
Weight lifting
When was the last time you had a check-up with your doctor?






What age group do you fall under?
What is your employment status?






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