* 1. How often do you go to the doctor in a month?

* 2. Do you have transportation to get to the doctor?

* 3. Do you smoke?

* 4. Do you feel that you are healthy?

* 5. Do you eat at least three balanced meals a day?

* 6. How many servings of fruits and vegetables do you eat everyday?

* 7. Do you feel like you get enough rest each night?

* 8. How many hours do you sleep each night?

* 9. What do you most often do for exercise?

* 10. In a typical week, how many days do you exercise?

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