I eat breakfast
Never
Sometimes
Often
Always
I exercise
Never
Once a week
3-4 times/week
5+ week
- select -
Special dietary needs
Moderate to severe heart disease
High blood pressure
Gluten intolerance
None
My lifestyle is
Incredibly busy
Pretty busy
Well balanced
Not busy at all
I eat
Whatever I can when I find the time
Some healthy foods but not usually
Healthy meals more than half the time
Healthy balanced almost all the time
How Important are organic foods to you?
Not important
Somewhat important
Very important
Male
Female
What is your current weight?
pounds
What is your realistic goal weight?
pounds
About how much do you spend on groceries for yourself each week?
On average, how many times per week do you go out to:
Breakfast?
Lunch?
Dinner?
E-mail Address
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