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ADULT: OFF HOME DIRECTORY SEARCH RANDOM POLL MAKE A POLL

Weight Survey

What is your gender?
Male
Female
What is your ethnicity?
American Indian/Alaska Native
Asian
Black/African American
Hispanic/Latino
Native Hawaiian/Other Pacific Islander
Two or More Races
White
What age group do you belong to?
0 - 10 Years
11 - 20 Years
21 - 30 Years
31 - 40 Years
41 - 50 Years
51 - 60 Years
61 - 70 Years
71 - 80 Years
81 - 90 Years
91 - 100 Years
What is your income level?
$0 - $15,000
$15,001 - $30,000
$30,001 - $45,000
$45,001 - $60,000
$60,001 - $75,000
$75,001 - $90,000
$90,001 - $105,000
$105,001 - $120,000
$120,001 - $135,000
$135,001 - $150,000
$150,001 - $165,000
$165,001 - $180,000
$180,001 - $200,000
$200,000+
What is your zip code?
What is your height in inches?
What is your weight in pounds?
How do you feel about your weight?
Severely Underweight
Moderately Underweight
Slightly Underweight
Normal Weight
Slightly Overweight
Moderately Overweight
Severely Overweight
How many hours a week on average do you exercise?
<1
1
2
3
4
5
6
7
8
9
10
11+
How many times a week do you on average eat fast food or at a restaurant?
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16+
How many hours a day are you in front of a screen (TV, Computer, etc)?
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16+
How many sodas per day do you drink?
0
1
2
3
4
5
6
7
8
9
10+
This poll was created on 2010-12-30 00:09:17 by jjl0242