健康早餐问卷Online Nutrition Club Survey Form

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How should I address you? 可以如何称呼您？* This field is required.

2

Your contact number 您的联络号码* This field is required.

3

Gender 性别* This field is required.

Female 女

Male 男

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1. What breakfast do you take normally ? 您的早餐是什么?* This field is required.Can choose more than 1 answer. 可以选多过一个答案。

Don't take any breakfast 没吃早餐

Noodles 面类

Nasi Lemak 椰浆饭

Bread 面包

Coffee or Tea 咖啡或茶

Other

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2. How much is your daily breakfast? MYR* This field is required.请问您的一份早餐大约多少钱？

< RM 5.00

RM5.00 - RM 9.99

RM 10.00 - RM 14.99

>RM 15.00

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3. Do you think your breakfast provides all the nutrients that your body needs in a day?* This field is required.您认为您的早餐有提供您一天所需要的营养吗？例如：矿物质，维他命及蛋白质。

Yes 有

No 没有

Not sure 不清楚

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4. Do you drink 8 glasses of water everyday?* This field is required.请问您一天有喝8杯水吗？

Yes 有

No 没有

Not sure 不清楚

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5. If there is a healthy breakfast can help you to improve energy, improve body conditions and at the same time improve immunity and as a bonus help you to lose/ gain weight. Are you interested to know more?* This field is required.假如有份营养早餐可以帮助您提升精神体力，改善体质，同时可以提高免疫系统，还可以增重/减重，请问有兴趣了解吗？

Yes, interested. 有兴趣

No, thank you. 没兴趣

Can consider. 可以考虑

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6. What do you would like to know more: 请问您想多了解的是：* This field is required.可以选多过一个答案。Can choose more than 1 answer.

Improve body condition, energy and increase immunity. 改善体质

Lose fat, lose weight. 减脂，减重

Gain weight. 增重

Nothing specific. 不需要

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7. Would you consider to replace your usual breakfast options with a balanced nutrition breakfast costing only RM8.60？* This field is required.如果有一份均衡营养早餐代替传统早餐可以改善健康，而只需RM 8.60, 您想要吗?

Yes. 要

No. 不要

Can consider. 可以考虑

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8. How much weight (kg), would you like to gain or lose?您想要减重或增重几公斤？

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9. Kindly provide your Height (cm), Body weight (kg), and Age. I will calculate your Magic Number and Personal Meal Plan for you.请填写您的个人身高(cm),体重(kg), 和年龄。我会送您一个属于您的神奇数字和饮食餐单。

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Appointment

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