Exercise Card Questionnaire

To complete the questionnaire and submit it for a $5 rebate, please:

Print and complete this page.

Mail to: Diana Designs
             160 River Forest Drive
             Fayetteville, GA 30214                     
                         
(Your name and address will NOT be shared with anyone. If you'd like to complete
the questionnaire anonymously and skip the rebate, you can submit it without your
name and street address. A city and state would still be appreciated. Thanks!)

Name:                 _________________________________________                                                                  


Mailing address:  _________________________________________

                           _________________________________________

                       

Email address:     _________________________________________

Age:  ______              Sex:  ______

1.  How long have you been using the exercise cards?

2.  Do you like the card format?

3.  Are the directions/explanations easy to understand?

4.  Do you think you're performing the exercises correctly?

5.  Did you learn anything new?                        
     If yes, what?

6.  Have you taken the cards on trips?

7.  Do you exercise to music, the TV, with a companion, etc.?      
     Please specify:

8.  Have you noticed any improvements in how you feel and look?
     If yes, what?

9.  Did you decrease your body fat or see improvements in things like blood pressure,
     blood sugar levels, cholersterol, etc.?
     If yes, what?

10. Was the program worth your money?

11. Would you recommend the cards to family, friends, and co-workers?

12. Did you visit the website?

13. Did you try any of the recipes?                  
      If yes, which one(s)?

      Did you like it/them?

14. What other information would you like added to the cards or website?

15. Do you think the cards should be distributed, for free, through a healthcare provider,
      insurance company, or employer?                

     Do you think this would encourage more people to exercise?

16. Do you think, in view of rapidly escalating healthcare costs, that individuals have a
      responsibility to live healthier lifestyles in order to reduce their risks for chronic diseases?

17. Does your healthcare provider give you the information you need to live a healthier lifestyle?
      If not, who does?

18. Have your insurance premiums risen much in the past several years?

     If yes, give an example:

ADDITIONAL COMMENTS, SUGGESTIONS, ADVICE: