Survey

Tell us about your fruit & vegetable consumption and physical activity.

On average, how many servings of fruits do you eat every day?
1 – 3 4 – 5 6 – 9 0, I don’t eat fruits

What is your favorite fruit?

On average, how many servings of vegetables do you eat every day?
1 – 3 4 – 5 6 – 9 0, I don’t eat fruits

What is your favorite vegetable?

How many sodas have you had today?
1 – 2 3-4 4+ 0, I don’t drink sodas

How much time do you spend on the following activities each day?

Watching TV? 1 – 30 minutes 31 – 60 minutes 1 hour – 1 ½ hours 1 ½ hours – 2 hours 2 hours +
Playing video games/computer games? 1 – 30 minutes 31 – 60 minutes 1 hour – 1 ½ hours 1 ½ hours – 2 hours 2 hours +
Being physically active? i.e. sports, playing outside, walking 1 – 30 minutes 31 – 60 minutes 1 hour – 1 ½ hours 1 ½ hours – 2 hours 2 hours +

What sports or activities do you enjoy?

Tell us about yourself……….

Your age:
Male Female
Zip Code:

Please copy and paste this survey into email, answer questions and submit this survey to nward@co.riverside.ca.us

Thanks for your input.

 

For additional information on all programs in Nutrition Services, please call (951) 358-5311.
For WIC information and appointments, call 1-800-455-4942 from within Riverside County,
or 1-951-358-7200 from outside Riverside County.
Loving Support Breastfeeding 24-hour Helpline, 1-888-451-2499.

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