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Survey (optional) 1. Marital Status: Single Divorced Married Widowed
2. How Many children under 12 in your household? 0 1 2 3 4 5 6 7+
3. How many times a week do you exercise? 0 1 2 3 4 5 6 7
4. Occupation (check one only). Homemaker Craftsman/Tradesman Professional/Technical Sales/Services/Middle Mgmt. Upper Mgmt/Administration Clerical/White Collar Other
5. Which categories describe your diet? Primarily Vegetarian (some chicken or fish) Vegetarian (no meat) Vegan (no meat or dairy) Some Organic Products Only Organic Products
6. What products do you buy in your health food store? (check all that apply) Vitamins Other Supplements Herbs Health & Beauty Aids Organic Products/Health Foods Weight Loss None of the Above
7. What types of complementary health care do you use? (check all that apply) Homeopathy Naturopathy Aromatherapy Acupuncture Massage Therapy Chiropractor Ayurveda Nutritionist None of the Above
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