Health Champions

Please Note: this is a test survey.

Aim: to demonstrate the different options open to you to capture data.

Question Title

* 1. What is your name? (Single TEXT BOX)

Question Title

* 2. Best way to contact you? Phone? Email? (Multiple Choice)

Phone

Email

Facebook

Whats App

Other (please specify)

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* 3. Happy heat up or home cooked? (Matrix? Rating Scale)

	Heat Up	Home cooked	A bit of both
Breakfast	Breakfast Heat Up	Breakfast Home cooked	Breakfast A bit of both	Breakfast
Lunch	Lunch Heat Up	Lunch Home cooked	Lunch A bit of both	Lunch
Pack Lunch	Pack Lunch Heat Up	Pack Lunch Home cooked	Pack Lunch A bit of both	Pack Lunch
Dinner	Dinner Heat Up	Dinner Home cooked	Dinner A bit of both	Dinner
Snacks	Snacks Heat Up	Snacks Home cooked	Snacks A bit of both	Snacks

Other (please specify)

Question Title

* 4. What is your age group? (Multiple Choice)

10-20

20-40

40-60

60+

Other (please specify)