Healthy Living Questionnaire Template - Ymca At Norton Commons (Page 4 of 4) in pdf

Please list the types of beverages and the amount of each you consume on a typical day:

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Have you ever used a food journal or food tracking app or program?

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PHYSICAL ACTIVITY INFORMATION

What is the most physically active thing you do in an average day? _______________________________

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What, if any, regular exercises do you do? How often and for how long do you participate? ___________

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Do you know of any reason (s) why you should not do physical activity? Yes No

If yes, please explain the reasons: _________________________________________________________

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Please provide any additional information that may be helpful or necessary:

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Healthy Living Questionnaire Template - Ymca At Norton Commons Page 4