1. How often do you engage in physical activity (30+ minutes)?
— Choose — Never Rarely Sometimes Often Always

2. How frequently do you consume processed or high-fat foods?
— Choose — Always Often Sometimes Rarely Never

3. Do you monitor your blood pressure regularly?
— Choose — Never Rarely Sometimes Often Regularly

4. Do you experience shortness of breath or chest pain during light activity?
— Choose — Always Often Sometimes Rarely Never

5. How often do you include fruits and vegetables in your meals?
— Choose — Never Rarely Sometimes Often Always

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