| Example: | Your health is: |
| excellent ......[ ] good ............[ ] fair ..............[ ] poor ............[ ] |
|
| Your health is: | |
| [ ] excellent [ ] good [ ] fair [ ] poor |
| Example: | Your health is: |
| excellent ......[ ] good ............[ ] fair ..............[ ] poor ............[ ] |
|
| Your health is: | |
| [ ] excellent [ ] good [ ] fair [ ] poor |