SPORTS AND HEALTH SURVEY

1. What is your age?

18 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65 to 74

75 or older

2. Are you male or female?

Male

Female

3. What is your nationality?

Asian

Arab (gulf)

Arab (non-gulf)

African

Westerner

5. What do you most often do for exercise?

(Please select all that apply.)
Lift weights

Walk

Run

Hike

Swim

Dance

Pilates

Play a team sport

Other (please specify)

6. Rank the following from most to least (1-3)

important to you.
Eat meals properly.
Sleep early.
Exercise.

7. Please tick the answer you most agree with:

Statements

Strongly
agree

Agree

Neutral

Disagree

Strongly
disagree

Working out
benefits the
body.
It important
to eat
balanced
3

nutritious
meals.
Regular
physical
exams are
needed.
Health and
sports are
related

8. How often do you exercise per week?

I dont

1 to 3 sessions

4 to 6 sessions

+7 sessions

9. In the last 12 months, how many times

did you visit your healthcare provider?
None

1 to 3 times

4 to 6 times

+7 times

10. Using any number from 0 to 10, where 0 is

the worst possible and 10 is the best possible.
A) What number would you use to rate how well
did your doctor explain your follow-up care?
B) What number would you use to rate your
health plan?
10

Best

Worst

possib

possib

le

le

A)
B)