Page 131 - When surgery alone won’t cut it - Valerie Maureen Monpellier
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8. How much do you smoke?
Very rarely
Socially (less than 2 cigarettes per week) less than 5 cigarettes per day
5-10 cigarettes per day
11-20 cigarettes per day
21-40 cigarettes per day
More than 40 cigarettes per day
9. Do you use drugs or have you used drugs (daily or weekly)? Yes, but I have quite (go on to question number 10)
Yes, I use ................................................
No (go on to question number 11)
10. If you have quit, when did you quit? ...............................
11. Have you had a pregnancy in the last 12 months or do you want children in the near future?
yes No
12. Have you experienced major live-events, like a divorce or death of a close family member, in last 12 months?
yes No
13. Howfrequentlydoyouexercise?
Not at all (go on to question number 16) Once per month or less
Several times per month
Once per week
Several times per week
Once per day
Several times a day
14. If you exercise, how long do you exercise each time? Less than 15 minutes
15-30 minutes
31-60 minutes
61-120 minutes
More than 120 minutes
15. Where do you do most of your exercise? Inside
Outside
16. If you exercise, please indicate the types of exercise you do (fill in all that apply):
145
Cycling
Stationary bike
Swimming
Stairmaster
Zumba
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