Healthy Choice Challenge
Exit this survey
1
. How did you hear about Healthy Choice Challenge?
How did you hear about Healthy Choice Challenge?
*
2
. What is your first and last name?
What is your first and last name?
*
3
. What is your mailing address?
What is your mailing address?
Name:
Address:
City/Town:
State:
-- select state --
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP:
Country:
Email Address:
Phone Number:
*
4
. Record your activities.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Week 1
more fruit
more vegies
more water
more low fat milk
no sugary drinks
walking
hiking
running
playing sports
less television
less computer
Record your activities. Week 1 Monday
more fruit
more vegies
more water
more low fat milk
no sugary drinks
walking
hiking
running
playing sports
less television
less computer
Tuesday
more fruit
more vegies
more water
more low fat milk
no sugary drinks
walking
hiking
running
playing sports
less television
less computer
Wednesday
more fruit
more vegies
more water
more low fat milk
no sugary drinks
walking
hiking
running
playing sports
less television
less computer
Thursday
more fruit
more vegies
more water
more low fat milk
no sugary drinks
walking
hiking
running
playing sports
less television
less computer
Friday
more fruit
more vegies
more water
more low fat milk
no sugary drinks
walking
hiking
running
playing sports
less television
less computer
Saturday
more fruit
more vegies
more water
more low fat milk
no sugary drinks
walking
hiking
running
playing sports
less television
less computer
Sunday
Week 2
more fruit
more vegies
more water
more low fat milk
no sugary drinks
walking
hiking
running
playing sports
less television
less computer
Week 2 Monday
more fruit
more vegies
more water
more low fat milk
no sugary drinks
walking
hiking
running
playing sports
less television
less computer
Tuesday
more fruit
more vegies
more water
more low fat milk
no sugary drinks
walking
hiking
running
playing sports
less television
less computer
Wednesday
more fruit
more vegies
more water
more low fat milk
no sugary drinks
walking
hiking
running
playing sports
less television
less computer
Thursday
more fruit
more vegies
more water
more low fat milk
no sugary drinks
walking
hiking
running
playing sports
less television
less computer
Friday
more fruit
more vegies
more water
more low fat milk
no sugary drinks
walking
hiking
running
playing sports
less television
less computer
Saturday
more fruit
more vegies
more water
more low fat milk
no sugary drinks
walking
hiking
running
playing sports
less television
less computer
Sunday
Week 3
more fruit
more vegies
more water
more low fat milk
no sugary drinks
walking
hiking
running
playing sports
less television
less computer
Week 3 Monday
more fruit
more vegies
more water
more low fat milk
no sugary drinks
walking
hiking
running
playing sports
less television
less computer
Tuesday
more fruit
more vegies
more water
more low fat milk
no sugary drinks
walking
hiking
running
playing sports
less television
less computer
Wednesday
more fruit
more vegies
more water
more low fat milk
no sugary drinks
walking
hiking
running
playing sports
less television
less computer
Thursday
more fruit
more vegies
more water
more low fat milk
no sugary drinks
walking
hiking
running
playing sports
less television
less computer
Friday
more fruit
more vegies
more water
more low fat milk
no sugary drinks
walking
hiking
running
playing sports
less television
less computer
Saturday
more fruit
more vegies
more water
more low fat milk
no sugary drinks
walking
hiking
running
playing sports
less television
less computer
Sunday
Week 4
more fruit
more vegies
more water
more low fat milk
no sugary drinks
walking
hiking
running
playing sports
less television
less computer
Week 4 Monday
more fruit
more vegies
more water
more low fat milk
no sugary drinks
walking
hiking
running
playing sports
less television
less computer
Tuesday
more fruit
more vegies
more water
more low fat milk
no sugary drinks
walking
hiking
running
playing sports
less television
less computer
Wednesday
more fruit
more vegies
more water
more low fat milk
no sugary drinks
walking
hiking
running
playing sports
less television
less computer
Thursday
more fruit
more vegies
more water
more low fat milk
no sugary drinks
walking
hiking
running
playing sports
less television
less computer
Friday
more fruit
more vegies
more water
more low fat milk
no sugary drinks
walking
hiking
running
playing sports
less television
less computer
Saturday
more fruit
more vegies
more water
more low fat milk
no sugary drinks
walking
hiking
running
playing sports
less television
less computer
Sunday
5
. Please rate your experience of Healthy Choice Challenge.
Please rate your experience of Healthy Choice Challenge.
Very bad
Bad
Neutral
Good
Very good
6
. Based on your rating, what did you like or dislike most about the challenge?
Based on your rating, what did you like or dislike most about the challenge?
7
. Please let us know how can we improve the Healthy Choice Challenge?
Please let us know how can we improve the Healthy Choice Challenge?
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