5210 Pre Survey (Taylor County) Question Title * 1. Please provide your first and last name (to be entered into prize drawings). Question Title * 2. Where do you work? Question Title * 3. Please provide your phone number (to be contacted for prize drawings). Question Title * 4. Do you eat 5 or more servings of fruits and vegetables daily? Yes No Question Title * 5. Outside of work or school, do you spend more than 2 hours per day watching TV or on an electronic device? Yes No Question Title * 6. Do you perform 1 hour or more of physical activity per day? Yes No Question Title * 7. Do you drink 1 or more sugar sweetened drinks per day? Yes No If yes, how many do you drink? Question Title * 8. Please provide any comments you may have regarding the 5-2-1-0 program: Done