Sample Survey 2005

What is your gender?
Female
Male


In this question, we ask you about some personal information:
What is your age?
What is your weight? (Round to whole kilos)
What is your hight in centimeters?


Do you agree or disagree to these statements?

  Fully Agree Partly Agree Partly Disagree Fully disagree
I find ny weight adequate, compared to my height
I feel in good physical shape
I am often trying to loose weight


What do you typically eat during the day?
Breakfast
Rolls
Oats
Cornflakes
Bacon
Tomatoes
Danish Pastry

Lunch
Fish
Poultry
Salat
Vegetables
Pasta

Dinner
Rice
Potatoes


Which main course did you get yesterday?
Please also write, if you don't remember, what you got.