健康與生活問卷調查
Health and Lifestyle Survey

 

  1. 您認為自己日常生活是屬於?
    Which of these words best describes your own lifestyle?
    平靜 Calm 活躍 Active 緊張 Stressed

  2. 您是否每天都能夠攝取百分百身體所需的營養呢?
    Do you think you get 100% of the daily nutrition needed for good health?
    能夠 Yes 不能夠 No 有時能夠 Sometimes

  3. 您有否使用營養補充食品 (維他命 / 礦物質 / 蛋白質) 呢?
    Do you take nutritional supplements (vitamins / minerals / proteins)?
    每天食用 Daily 從不食用 Never 有時食用 Sometimes

  4. 您是否會在白天覺得體力不支呢?
    Do you experience a loss of energy during the day?
    是 Yes 否 No 偶然 Occasionally

  5. 您或您的任何家庭成員或朋友中，有沒有需要控制體重的呢?
    Do you, or does any member of your family or friends need to control, gain or maintain weight?
    需要減重 Lose weight 需要增重 Gain weight
    不肯定 Can't say for certain 保持體重 Maintain weights

  6. 您 / 他們大概需要減去多少磅呢?
    Approximately how much weight do you / they need to control?
    您 You 磅 lbs
    家庭成員 Family 磅 lbs 磅 lbs 磅 lbs
    朋友 Friends 磅 lbs 磅 lbs 磅 lbs

  7. 您是否曾經嘗試過控制飲食的體重控制計劃呢?
    Have you tried diet programmes in the past?
    是 Yes 否 No 哪一種? Which ones?

  8. 您每天的飲食是否已包含所有基本的營養食品呢?
    Do you eat a variety of healthy foods from the basic food groups everyday?
    是 Yes 否 No

  9. 如沒有，為什麼呢?
    If no, why not?
    沒有足夠時間買或準備 Not enough time for shopping / preparation
    太昂貴 Too expensive 太複雜 Too complicated

  10. 您有沒有興趣認識一種既能照常吃心愛食物，而又不會感到肚餓的控制體重營養計劃呢?
    Are you interested in learning about a nutritional programme to control weight while still eating the foods you like, without feeling hungry?
    有興趣 Yes 沒有興趣 No

  11. 什麼時間最適合聯絡您或打電話給您?
    When is the most suitable time to contact or telephone you?
    日間 Day time 晚間 Night time

  12. 您喜歡我們將進一步的資料郵寄或電郵給您?
    Would you prefer further information to be sent to you by post or email?
    郵寄 By post 電郵 Email


姓名 Name:

性別 Sex：男 Male女 Female

年齡 Age：10-1819-2526-3536-4546-5555以上 Over

現時體重 Weight：lbs

現時身高 Height：cm

電郵 Email:

地址 Address:

聯絡電話 Telephone Number:

您認識什麼人會喜歡參與這個調查的呢?
Is there anyone else you know who would take part in this survey?

姓名 Name: 電話 Telephone: 電郵 Email:
姓名 Name: 電話 Telephone: 電郵 Email:
姓名 Name: 電話 Telephone: 電郵 Email:

　





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