HEART HEALTH SURVEY
INTRODUCTION: We are studying attitudes about cardio health and healthy eating habits. Your feedback will be
anonymous
and will help to shape the educational materials and healthy products that are made available to Americans. Please begin the survey now.
Please indicate whether you are concerned about any of these cardio health problems. . . .
(check all that apply)
Concerned for Myself
I've Been Diagnosed With This Condition
Concerned for a Family Member
Heart attack
Heart disease
High blood pressure
High cholesterol
Peripheral Artery Disease (PAD)
Stroke
Have any of your close relatives suffered from cardio health problems? If yes, please indicate which relatives.
(check all that apply)
None
Mother
Father
Brother
Sister
Grandparent
Son/Daughter
Don't Know
Would you like to learn more about any of these health topics? (check all that apply)
exercise
healthy recipes
cholesterol control
oral care
proper diet
blood pressure control
none
Other
What brand(s) of
Probiotic Yogurts
have you
heard of
, have you
bought in the last 3 months
, and which ones do you
plan to buy next
? (Please complete all 3 columns, marking any that apply)
Heard Of
Bought in Past 3 Months
Plan to Buy Next
Breyer’s Light
Dannon Activia
LaYogurt
Stonyfield Farms
Yoplait Yo-Plus
Store brand probiotic yogurt
Other
None/Don’t know
What type of soup do you prefer? (check all that apply)
None
“Better for you”
Canned
Dried
Healthy Request (Campbell's)
Lite
Lower sodium/salt
Regular
Other
Please contact
survey@adialogue.com
if you have any questions regarding this survey.
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