Template Borang Perundingan Templat soal selidik Tabiat Sihat

Templat soal selidik Tabiat Sihat

Templat soal selidik Tabiat Sihat

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20
Questions
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Healthy Habits Questionnaire Template

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1.
Which kind of breakfast do you usually have?[Kotak semak]
Cereal or pastries
Cooked breakfast (full English)
Coffee or tea only
Toast
Protein shake or smoothie
I skip breakfast
Other
2.
How often do you skip breakfast?[Kotak semak]
Never
3 times or less per week
More than 3 times per week
Always
3.
Do you feel hungry or tired before lunchtime?[Kotak semak]
Yes
No
4.
What do you typically eat for lunch?[Kotak semak]
Fast food or meal deal
Packed lunch or sandwich
Fruit or yogurt
Cooked meal or salad
5.
On average, how long do your meals last?[Kotak semak]
Less than 10 minutes
10–29 minutes
30–59 minutes
60 minutes or more
6.
How many times do you usually chew before swallowing?[Kotak semak]
Fewer than 10 times
10 to 19 times
20 to 29 times
30 times or more
7.
When is your last meal relative to bedtime?[Kotak semak]
Within 2 hours before sleeping
More than 2 hours before sleeping
8.
When do you stop eating during a meal?[Kotak semak]
When about 80% full
When completely full (100% satiety)
9.
If you want a drink other than water, which would you choose?[Kotak semak]
Green tea
Black tea or other tea
Coffee (without sugar)
Coffee (with sugar)
Juice (non-carbonated)
Carbonated drinks
10.
What do you use to sweeten food or drinks?[Kotak semak]
Sugar
Other sweeteners
11.
How often do you snack after dinner?[Kotak semak]
3 times or more per week
Less than 3 times per week
12.
How often do you exercise?[Kotak semak]
Never
1-2 times a week
3-4 times a week
5-7 times a week
Other
13.
Would you describe your weight as:[Kotak semak]
Underweight
Overweight
About right
Prefer not to answer
14.
Do you have any weight loss or health goals?[Kotak semak]
Yes
No
Maybe
15.
Which goals do you want to achieve?[Kotak semak]
Weight loss
Inch loss
Tone up
Build lean muscle mass
Get fitter
Other
16.
How would you describe your gender?[Kotak semak]
Male
Female
Non-binary
I would like to skip this question
Prefer to self-describe
17.
What is your age group?[Kotak semak]
18-29
30-39
40-50
Over 50
18.
Would you like to learn how we can help you reach your goals with a few small changes?[Kotak semak]
Yes
No
Maybe
*
19.
Name
20.
Phone Number
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Template instructions
Templat soal selidik tabiat sihat membantu anda mengumpulkan maklumat tentang diet, senaman dan rutin harian individu. Gunakan tinjauan ini untuk menilai tingkah laku yang sihat, mengenal pasti bidang untuk penambahbaikan dan menyokong penetapan matlamat untuk pelajar, pelanggan atau pesakit.

Templat percuma ini termasuk soalan tentang tabiat sarapan pagi, jenis dan tempoh makan, makanan ringan, pilihan minuman, isyarat kenyang, kekerapan mengunyah, kekerapan senaman, persepsi berat badan dan matlamat kesihatan. Item demografi seperti umur dan jantina serta medan kenalan membolehkan anda membuat susulan.

Ia sesuai dengan guru pendidikan jasmani, jurulatih kecergasan, penyedia penjagaan kesihatan, program kesihatan dan sekolah. Sesuaikan perkataan, tambah penjenamaan, benamkan borang di tapak web atau kongsi pautan; Respons boleh dieksport atau disepadukan dengan alat lain untuk menjejaki kemajuan. Kumpulkan respons pada peranti mudah alih, eksport hasil ke hamparan atau berhubung dengan lebih 100 penyepaduan untuk mengautomasikan aliran kerja dan susulan untuk hasil yang lebih baik.

Klik "Gunakan Templat Ini" untuk menyesuaikan dan melancarkan soal selidik tabiat sihat anda hari ini.

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