| Subject number | |
| Sex |
|
| How old are you? | |
| In which country do you live? | _________________________________ |
| In which city? | _________________________________ |
| What is your current status? |
|
| What is your level of education? | |
| Employment |
|
| How much do you weight? (kg) |
|
| How tall are you? (cm) |
|
| Do you smoke? |
|
| Do you enjoy physical activity? |
|
| issue date |