1. What is your age? Under 18 Years Old 18 to 24 Years Old 25 to 30 Years Old 31 to 40 Years Old 41 to 50 Years Old 51 to 60 Years Old Over 60 Years Old 2. What is your gender? Male Female 3. What time do you go to bed? 7.30 p.m. 8.30 p.m. 9.30 p.m. 10.30 p.m. 11.30 p.m. After midnight 4. What time do you get up in the morning? Between 3:30 and 6:30 a.m. 7.30 a.m. 8.30 a.m. 9.30 a.m. 10.30 a.m After 11.00 a.m. 5. How many hours of sleep do you usually get? 1-4 hours 5-6 hours 7 hours 8 hours 9-10 hours 11 or more hours 6. What does it take to wake you up? The alarm clock on a low volume setting. The alarm clock on a normal setting. The alarm clock set so high that it can be heard throughout the house! You are waken up by someone else. The smell of breakfast wakes you up. It practically takes beating a drum next to your ear to wake you up! 7. What are you like when you first wake up? You're jumping for joy that it is morning! Happy that a new day has begun. You're neutral. You're kind of tired, but you are still easy enough to get along with. You're pretty grumpy, and you would like to be left alone. You scream when the first person says "good morning" to you. 8. How often do you brush your hair? About once an hour. About once every two to three hours. About four times a day. Once or twice a day. Every couple of days. I've never brushed my hair! 9. How often do you wash your hair? Twice a day. Once a day. Once every couple of days. Once a week. Once a month. I've never washed my hair! 10. How often do you take a shower? Twice a day. Once a day. Once every couple of days. Once a week. Once a month. I've never taken a shower! 11. What food group do you eat the most of? Wheats/pastas/cereals. Fruits. Vegetables. Dairy products. Meats. Fats/oils/sweets. 12. Do you take good care of your nails? Yes, they are cut regularly and kept up. They look pretty well. They look okay, I guess. They could use some work ... They've all been bitten ... Ew, they are so pitiful looking, I can't stand to look at them!!! 13. How often do you brush your teeth? Once a day. Twice a day. Three times a day. Four times a day. Once every couple of days. Once a week. 14. How long does it take for you to brush your teeth? 5 minutes. 3 minutes. 2 minutes. 50 seconds. 30 seconds. 15 seconds or less. 15. How many fillings have you had? None. 1-5. 6-10. 11-15. More than 15. Way too many to count. 16. How often do you floss? Twice a day. Once a day. Once every couple of days. Once a week. Once a month. Right before I go to the dentist. 17. How do you floss? Go through every single gap until it is all done. Skip some places. I've never flossed before! 18. How often are you stressed? 24/7. Half of the day, usually. Part of the day. A tiny bit of the day. Only a few times a week. Every once in a while. 19. Do you have any medical problems? Yes, gingivitis (or some other oral health problems) Asthma/Allergies. Acid Reflux Disease. Attention Deficit Disorder. More than one of these/other. None. 20. How often do you go to the doctor? Six times a year. Three times a year. Twice a year. Once a year. More than six times a year. None/once or twice in a lifetime. 21. How often do you go to the dentist for checkups? Four times a year. Twice a year. Once a year. Once every couple of years. Only when I have a toothache. Never. 22. Do you watch what you eat? Yes, 24/7. Most of the time. I try not to, but I just can't resist. I am supposed to, but I don't. I don't care what I eat, we all have to die of something. 23. How often do you exercise? More than six hours per day. 3-6 hours per day. 1-2 hours per day. Less than 1 hour per day. More than twice a week. Twice a week or less. 24. The truth: What is your weight status? I am underweight. I am close to normal, but on the underweight side. I am normal. I am at risk of becoming overweight. I am overweight. I am obese. 25. Do you care about your weight? Yes, very much. I really want to change. Yes, very much but I am satisfied already. No, not really. Who cares about weight when you can go eat chocolate? 26. Last question:
DO YOU THINK YOU ARE HEALTHY? Yes, why not? I think so. I better be. No, not really. I'd be surprised if I was. I don't know.