EXIT THIS SURVEY Diet & Exercise Template Question Title * 1. How many veggies does your child eat a day? 1-3 4-Up Clear i We adjusted the number you entered based on the slider’s scale. OK Question Title * 2. Does your child take nutritional supplements? Yes No OK Question Title * 3. How important is exercise to your family? Not at all important Extremely important Clear i We adjusted the number you entered based on the slider’s scale. OK Question Title * 4. What does your family most often do for exercise? Lift weights Walk Run Hike Swim Dance Aerobics Pilates Play a team sport Other (please specify) OK Question Title * 5. Does your family participate in any Holistic Art camps or classes? And, if so, how many? Yes No 1 2 3 or more OK Question Title * 6. In a typical day, how many of your meals or snacks include carbohydrates? OK Question Title * 7. In a typical day, how many of your meals or snacks include protein? OK Question Title * 8. In a typical day, how many of your meals or snacks include vegetables? OK Question Title * 9. In a typical day, how many of your meals or snacks include fruit? OK Question Title * 10. In a typical day, how many organic meals does your family eat? OK DONE