BBM Entrance survey Question Title * 1. how many times did you have full sugar fizzy drinks this week? 0 100 Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 2. how many times did you have diet fizzy drinks this week to? 0 100 Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 3. how many times did you have fruit juice this week? 0 100 Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 4. How many times did you eat takeaways or fast foods this week? Never 1-3 times 4-6 times 7-9 times 10 or more times Question Title * 5. How many times did you eat bread/carbs this week? 0 100 Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 6. How many times a day do you eat sweets (like chocolates, candy, cookies, etc.)? 0 100 Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 7. How many times per week do you exercise or work out? Every day of the week Several times per week Once per week Less than once per week I never work out or exercise Question Title * 8. In the past 30 days, how many times did you exercise for at least 30 minutes? Not at all 1 to 4 times 5 to 8 times 9 to 12 times More than 12 times Question Title * 9. About how many cigarettes do you smoke in a typical day? Question Title * 10. How many days a week do you drink alcohol? Question Title * 11. When you drink alcohol, how many drinks do you usually have? (1 drink=1 can of beer or a small glass of wine)? 0 1-4 5-8 9-12 13-16 More than 16 Question Title * 12. Do you have any injuries that we ought to know about? Yes No Question Title * 13. If yes, what might that be? Over the past 2 weeks, how often have you been bothered by any of the following problems? Question Title * 14. Having little interest or pleasure in doing things Not at All Several Days More Than Half the Days Nearly Every Day Question Title * 15. Feeling down, depressed, or hopeless Not at All Several Days More Than Half the Days Nearly Every Day Question Title * 16. Having trouble falling or staying asleep, or sleeping too much Not at All Several Days More Than Half the Days Nearly Every Day Question Title * 17. Feeling tired or having little energy Not at All Several Days More Than Half the Days Nearly Every Day Question Title * 18. Having a poor appetite or overeating Not at All Several Days More Than Half the Days Nearly Every Day Question Title * 19. Feeling bad about yourself — or that you are a failure or have let yourself or your family down Not at All Several Days More Than Half the Days Nearly Every Day Question Title * 20. Having trouble concentrating on things, such as reading the newspaper or watching television Not at All Several Days More Than Half the Days Nearly Every Day Question Title * 21. Moving or speaking so slowly that other people could have noticed? Or the opposite being so fidgety or restless that you have been moving around a lot more than usual Not at All Several Days More Than Half the Days Nearly Every Day Question Title * 22. Having thoughts that you would be better off dead or of hurting yourself in some way Not at All Several Days More Than Half the Days Nearly Every Day Question Title * 23. How difficult have any of these problems above made it for you to do your work, take care of things at home, or get along with other people? Not difficult at all Somewhat difficult Very difficult Extremely difficult Question Title * 24. How did you hear about this position? Social Media Word of Mouth TV Not until I was contacted and invited to Join Other (please specify) Question Title * 25. On your first day at BBM, did you know anyone else in your group? No, I didn’t know anyone Yes, I came with someone I already knew I know someone who is part of BBM (including following Dave Letele) Other (please specify) Question Title * 26. Please leave your name, phone and email address Name * Email Address Phone Number * Question Title * 27. Client ID Done
