On average, how many servings of fruits and vegetables do you consume per day?

• 0-1
• 2-5
• 6-10

On average, how many servings of dairy products do you consume per day?

• 0-1
• 2-5
• 6-10

On average, how many servings of fish (salmon, tuna, mackerel or sardines) do you consume per week?

• None
• 1-2
• 3 or more

How many times a week do you exercise for at least 30 minutes?

• Less than 3 time's a week
• 3-4 times a week
• 5-7 times a week

Do you smoke or are you exposed to second hand smoke or chemical pollutants on a regular basis?

• Yes
• No

What's your physical, mental or emotional stress level?

• Minimal
• Moderate
• Extreme

Are you pregnant or breastfeeding?

• Yes
• No

Do you participate in strenuous physical activity (i.e weight lifiting, sports etc) on regular basis?

• Yes
• No