APPENDIX C QUESTIONNAIRE Instructions: This section will help determine the current level of wellness that you are

experiencing. We hope that it will also give you ideas for areas in which you might improve. Please answer each item by putting a check mark ( / ) on the column of the letter corresponding to your choice. Below are the interpretations of your choices:

A. Almost always this is true (90% or more of the time) B. Very frequently this is true (approximately 75% of the time) C. Frequently this is true (approximately 50% of the time) D. Occasionally this is true (approximately 25% of the time) E. Almost never this is true (less than 10% of the time) QUESTIONS A B C D E

4. I approach exercise in a relaxed manner. 5. I stretch before exercising. (5 ang 6 dapat daw pagsamahin pero parang di pwede kasi bawal ang double question sa isang item) 6. I stretch after exercising. 7. I walk or bike whenever possible. 8. When feeling tired, I arrange for sufficient sleep. 9. I participated in a strenuous sport (tennis, running, swimming, hand ball, basketball, etc.) 10. I put gear of good quality, designed for the activity in which I participate.

11. If I am not in shape, I avoid sporadic (once a week or less often) strenuous exercise. A 12. After vigorous exercise, I cool down (very light exercise such as walking) for at least five minutes before sitting or lying down. 13. When choosing non- vegetable protein, I select lean cuts of meat, poultry and fish. 14. I maintain an appropriate weight for my height and frame. 15. I minimize salt intake. 16. I eat fruits and vegetables fresh and uncooked. 17. I eat breakfast. 18. I intentionally include fiber in my diet on a daily basis. . 20. I plan my diet to ensure an adequate amount of vitamins and minerals. 21. I minimize foods in my diet that contain large amounts of refined flour (bleach white flour, typical store bread, cakes, etc.) 22. I minimize my intake of fats and oils including margarine and animal fats. 23. I include items from all for basic food groups in my diet each day (fruits and vegetables, milk group; breads and cereals; meat, fowl, fish, or vegetable proteins). 24. To avoid unnecessary calories, I choose water as one of the beverages I drink. 25. I avoid adding sugar to my food and I minimized my intake of pre-sweetened foods such as sugarcoated cereals, syrups, chocolate milk, and most processed and fast foods 26. I record immunization to maintain up-to-date immunization records. B C D E

27. I examine my breasts or testes examined yearly by a physician. A 28. I have a cervical examination annually (Males-do not mark). 29. I take action to minimize my exposure my tobacco smoke. 30. When Im experiencing illness or injury, I take necessary steps to correct the problem. 31. I brush my teeth after eating. B C D E

34. I get an adequate amount of sleep. 35. I engage in activities that keep my blood pressure in a range that minimizes my chances of diseases (e.g., stroke, heart attack, and kidney disease). 36. I select foods that keep my cholesterol level, high-density lipids, and triglycerides in a range that minimizes my chances of diseases. 37. If I were to engage in sex and didnt want children at that time I would use a contraceptives. 38. I take action to prevent contracting and/or transmitting venereal disease.

40. I use drugs only when necessary. 41. I avoid the use of tobacco. 42. I consume two alcoholic drinks per day or less. 43. Because of the potentially harmful effects of caffeine (e.g., coffee, tea, colas, etc.) I limit my consumption. 44. I avoid unprescribed medicines

A 46. I follow the instructions provided with any drug I take. 47. I avoid using drugs obtained from unlicensed sources. 48. I understand the expected effect of drugs I take.

Yan ung natandaan ko may gusto syang paremove kasi daw yung iba parang pauulit2 na yung questions tapos yung ibang term pinapalitan nya dapat daw laymans term.