Your Gender
*
Please Select
Female - 女性
Male - 男性
Your Daily Meal
您的每日一餐
Which daily meal is most significant to you?
*
Breakfast - 早餐
Brunch - 早午餐
Lunch - 午餐
Dinner - 晚餐
Supper - 夜宵
What type of food do you normally take for your breakfast?
*
Egg (鸡蛋)
White Bread (白面包)/饼干
Wheat Bread (麦面包)
Noodle (面食)/Fried Bihun (经济米粉)
Nasi Lemak (椰浆饭)
Roti Canai
Bak Kuh Teh (肉骨茶)
Oat (麦片)
Vegetable (蔬菜)/Fruits (水果)
Milo
3 in1 Coffee/Coffee - 三合一咖啡/咖啡
Black coffee - 黑咖啡
Balanced diet breakfast - 营养均匀的早餐
Not applicable (没使用早餐的习惯)
Other
Where you normally take your breakfast?
*
Home - 家里
Outside - 外用
Office/Company - 公司
Not applicable (没使用早餐的习惯)
How many litre water you drink in a day?
*
Less than 1 litre - 少于1公升
1 - 2 litres (公升)
2 - 3 litres (公升)
3 - 4 litres (公升)
More than 4 litres - 超过4升
How much you spend for your breakfast?
*
MYR 5 below (以下)
MYR 5 - MYR 10
MYR 10 and above (以上)
Not applicable (没使用早餐的习惯)
Other
Your Daily Exercise
您的运动习惯
Do you like to exercise and how many times per week?
*
Everyday - 每天
One week once - 一个星期 1 次
One week twice - 一个星期 2 次
One week three times - 一个星期 3 次
One week four times - 一个星期 4 次
One week five times - 一个星期 5 次
One week six times - 一个星期 6 次
No - 没有
How long do you spend for your daily exercise?
*
30 minutes and below (分钟以下)
30 - 60 minutes (分钟)
60 - 120 minutes (分钟)
120 minutes and above (分钟以上)
Not applicable (没有做运动的习惯)
What is your intention to exercise?
*
Health - 健康
Weight Loss - 瘦身
Weight Gain - 增重
Reduce tension - 减压
Peer/spouse encouragement - 有伴
Hobby - 爱好
Doctor advice - 医生告知要做运动
Not applicable (没有做运动的习惯)
Your Family and Your Health
您与家人的健康
Are you or your family member having health problem?
*
Yes - 有
No - 没有
Are you or your family member facing any health problem?
*
Diabetes - 糖尿病
cholesterol - 胆固醇
High Blood Pressure - 高血压
Heart Disease - 心脏病
Overweight/Obesity - 肥胖
Stroke - 中风
Cancer - 癌症
Kidney Disease - 肾脏疾病
没有
Other
Do you or your family member take any supplements?
*
Yes - 有
No - 没有
Are you willing to replace your traditional breakfast with a balanced diet breakfast cost at MYR 7.60?
*
Yes - 愿意
No - 不愿意
Appointment
预约方式
I would like to
Understand what are the healthy breakfast all about (了解什么是健康的早餐)
Attend a 30 minutes health talk sharing session (出席一个30分钟的健康讲座分享会)
Find out a business opportunity regarding wellness products (寻找有关保健产品的商机)
Not interested at this moment (目前没有兴趣)
Other
Please leave us date and time
*
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Month
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Date
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Hour
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10
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30
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Minutes
AM
PM
AM/PM Option
Your Particulars
*
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