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Survey For MICET Student Of Healthy Lifestyle

Male Female

Degree Diploma

Age :

18 20
21 23
24 26
27 30
Others

Weight :

40kg 45kg
46kg 50kg
51kg 55kg
56kg 60kg
61kg 65kg
66kg 70kg
71kg 75kg
Others

Are you aware of your BMI?

Yes / No

How much water did you consume per day

1L 2L
3L 4L
How many hours do you sleep per week

Less than 56 hours

More than 56 hours

Do you play sports?

Yes

No

What kind of sport did you play? _________________________

How often do you play sport per week?

12
34
56

Do your family have any hereditary diseases?

Yes / No

What type of diseases?

__________________________________________________________________________

How often do you visit the hospital per years?

1 months
2 months
3 months

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