H.S.

B SBA Research Survey

We are Form 5 Human and Social Biology class students of Bishop Anstey High School East
and this survey is intended to record information regarding your health and fitness lifestyle.
It should take approximately two to five minutes of your time to complete this. Your
responses would be kept confidential. Please answer as honestly as possible.

1. Please input your email.

*

Your answer

2. Please state your name. *

Your answer

3. Please indicate your age. *

Your answer

4. Please indicate your date of birth. *

Your answer

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5. Please state your weight and specify the unit you are using. Eg. 66 kg or 145lbs *

Your answer

6. Please state your height and specify the unit you are using. Eg. 5 feet 7 inches or*
170 cm

Your answer

7. Select the most appropriate range for your BMI (Body Mass Index). If you do not*
currently know your BMI please select "I do not know." Mark only one option

Less than 18.5 (Underweight)

18.5 - 25 (Ideal weight) 25 - 30

(Overweight)
30 - 35 (Moderate Obesity)

35 - 40 (Obesity)

More than 40 (Morbidly

Obese) I do not know,

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8. Are there any health conditions in your family? *
Select all that apply.

Hypertension

Cancer

Diabetes

Heart Disease
Other:

9. Do any of your immediate family members have the health condition you *
indicated above?
Mark only one option.

Yes

No

10. Please identify the family members and health condition that they have. *

Your answer

11. Do you consider yourself healthy?

*
Yes

No

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12. Please explain your answer above.
*

Your answer

13. Do you have any health conditions? If yes, briefly explain.

*

Your answer

14. Do you consider your meals to be balanced? Please explain.

*

Your answer

15. Do you usually calculate how much calories you are consuming? *
Mark only one option

Often

Sometimes

Never
Too Frequently

16. How often do you do your cheat days with your meals?
*
Mark only one option

Often

Sometimes

Never
Too Frequently

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17. When you feel hungry between meals, what do you usually choose for a snack?
*

Your answer

18. How many glasses of water do you drink daily?

*
Mark only one option
0 - 1 glass

2 - 4 glasses

5 - 8 glasses

8 + glasses

19. Do you exercise? If no please explain why.

*

Your answer

20. How often do you exercise? *

Mark only one option

0 days a week

1-2 days a week 3-4 days a

week 5+ days a week

I do not currently exercise.

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21. How long do you exercise for?
*
Never

10 - 15 mins

20 - 30 mins

40 - 50 mins

1 Hour+

I do not currently exercise.

22. Are you usually consistent with your time to exercise? *

Yes No
I do not currently exercise.

23. Which of the following best describes your workout space? *

Mark only one option

Gym

Workout Videos At Home

Gym Personal Trainer

I do not currently exercise.

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24. Which of the following do you incorporate in your exercise routine? *
Select all that apply

Walking Lifting

Weights

Running/Jogging

Swimming

Cycling

Playing Sports

Cardio
Core Exercises

25. Which of the following best describes what stops you from working out often? *
Mark only one option

Time Motivation

Lifestyle
Busy Schedule

Health Conditions

26. Have you been tracking your fitness level in the last year? *

Yes

No

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27. Please explain the methods you have used to track your fitness level.
*

Your answer

28. Please select the statement that best suits your current health and fitness level *
Mark only one option

Very good, I'm proud of my fitness journey.

Okay, but I'd like to push myself more.

I need to improve.

I'm not happy with my fitness journey.

29. Please explain the challenges you have when it comes to your fitness journey/ *
goals.

Your answer

Forms

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