Chronic Health Problems Questionnaire

• Do you know if you’ve ever been diagnosed with a chronic disease? If so, which one?
• About how much do you weigh without shoes on?
• About how tall are you without shoes on?
• Has a health care professional ever told you that you have high blood pressure?
• Has a health care professional ever told you that you have high blood cholesterol?
• Has a health care professional ever told you that you have diabetes?
• Has a health care professional ever told you that you have arthritis?
• Have you smoked at least 100 cigarettes in your entire life?
• Do you smoke cigarettes everyday, some days or not at all? Has that always been the case?
• During the last month, other than your regular job, did you participate in any physical activities or exercises such as running, sports, gardening or walking for exercise?
• Not counting juice, how often do you eat fruit?
• How often do you eat green salad?
• How many servings of vegetables do you usually eat in a day?