1. I consume ___ servings of fruits and vegetables per day.

  • 0
  • 1 to 2
  • 3 to 4
  • 5
  • More than 5

2. I am physically active ___ minutes a week.

  • 30 or less
  • 60
  • 90
  • 120
  • 150 or more

3. I feel like my overall level of stress is ___ .

  • Low
  • Below Average
  • Average
  • Above Average
  • High

4. I have experienced anxiety.

  • Yes,
    at least once a week
  • Yes,
    at least once a month
  • Yes,
    within the last year
  • No,
    not within the last year
  • No, never

5. I have experienced depression.

  • Yes,
    at least once a week
  • Yes,
    at least once a month
  • Yes,
    within the last year
  • No,
    not within the last year
  • No, never