Appendix D: Health and Fitness Survey

(developed by Zofia Gehl, 2009)

Answer each question by circling the most applicable option.

1. How would you describe your fitness level.

poor average very good excellent

2. How often do you think about your health?

never or rarely sometimes often always

3. How would you rate your eating habits in terms of how healthy they are?

poor average very good excellent

4. Before trying a new activity or eating habit, how often do you consider how your
health will be affected by it?

never or rarely sometimes usually or often always

5. How important is your health and fitness to you?

not at all somewhat very extremely

6. When trying a new activity, how often do you consider whether it is safe before doing it?

never or rarely sometimes usually or often always