APPENDIX C QUESTIONNAIRE Instructions: This section will help determine the current level of wellness that you are

experiencing. We hope that it will also give you ideas for areas in which you might improve. Please answer each item by putting a check mark ( / ) on the column of the letter corresponding to your choice. Below are the interpretations of your choices:

A. Almost always this is true (90% or more of the time) B. Very frequently this is true (approximately 75% of the time) C. Frequently this is true (approximately 50% of the time) D. Occasionally this is true (approximately 25% of the time) E. Almost never this is true (less than 10% of the time) QUESTIONS A B C D E

4. I approach exercise in a relaxed manner. 5. I stretch before exercising. (5 ang 6 dapat daw pagsamahin pero parang di pwede kasi bawal ang double question sa isang item) 6. I stretch after exercising. 7. I walk or bike whenever possible. 8. When feeling tired, I arrange for sufficient sleep. 9. I participated in a strenuous sport (tennis, running, swimming, hand ball, basketball, etc.) 10. I put gear of good quality, designed for the activity in which I participate.

I eat fruits and vegetables fresh and uncooked. To avoid unnecessary calories. If I am not in shape. I select lean cuts of meat. breads and cereals. 14. 24. 23. typical store bread. I avoid adding sugar to my food and I minimized my intake of pre-sweetened foods such as sugarcoated cereals. syrups. I intentionally include fiber in my diet on a daily basis. or vegetable proteins). meat. I maintain an appropriate weight for my height and frame. fowl. I avoid sporadic (once a week or less often) strenuous exercise. I include items from all for basic food groups in my diet each day (fruits and vegetables. poultry and fish. 17. 18. chocolate milk. B C D E . I minimize salt intake. I choose water as one of the beverages I drink. 15. 16. 13. I “cool down” (very light exercise such as walking) for at least five minutes before sitting or lying down.11. I eat breakfast. and most processed and fast foods 26. etc.) 22. A 12. I record immunization to maintain up-to-date immunization records.vegetable protein. cakes. 20. milk group. fish. I plan my diet to ensure an adequate amount of vitamins and minerals. When choosing non. I minimize foods in my diet that contain large amounts of refined flour (bleach white flour. After vigorous exercise. I minimize my intake of fats and oils including margarine and animal fats. 25. . 21.

I get an adequate amount of sleep. etc. and kidney disease). If I were to engage in sex and didn’t want children at that time I would use a contraceptives. 37. 36. B C D E 34. 43. I take necessary steps to correct the problem. I use drugs only when necessary.) I limit my consumption. I take action to minimize my exposure my tobacco smoke. I examine my breasts or testes examined yearly by a physician. I consume two alcoholic drinks per day or less. 35. I take action to prevent contracting and/or transmitting venereal disease. colas. stroke.. high-density lipids. I select foods that keep my cholesterol level. 38. heart attack.27. I brush my teeth after eating. I avoid unprescribed medicines . and triglycerides in a range that minimizes my chances of diseases. Because of the potentially harmful effects of caffeine (e.. 30. 42. I engage in activities that keep my blood pressure in a range that minimizes my chances of diseases (e. 41. I have a cervical examination annually (Males-do not mark). 44. A 28. When I’m experiencing illness or injury. 31. coffee. I avoid the use of tobacco. 29. 40.g.g. tea.

B C D E Yan ung natandaan ko may gusto syang paremove kasi daw yung iba parang pauulit2 na yung questions tapos yung ibang term pinapalitan nya dapat daw laymans term.A 46. I avoid using drugs obtained from unlicensed sources. I follow the instructions provided with any drug I take. 48. 47. . I understand the expected effect of drugs I take.