How often do you take this Check Up? (Please select the answer that is closest) Choose one of the following answers First time More than once a week A couple times a month Monthly A number of times a year Twice a year Once a year No answer

Do you plan to take this Check Up again and, if so, how often? (Please select the answer that is closest) Choose one of the following answers More than once a week A couple times a month Monthly A number of times a year Once a year Twice a year I don't plan to take this again No answer

Do you plan to seek consultation as a result of your Check Up results? Check any that apply   No Yes, the next time I see my family Doctor for a routine visit Yes, I will schedule an appointment in the near term with my family Doctor Yes, through a psychologist Yes, through a psychiatrist Yes, through a social worker Yes, through my company's employee assistance program Yes, through a community support group Yes, through other resources

To what extent have you found your visit to be insightful and/or educational? Choose one of the following answers To a great extent To some extent So/so Not very much Not at all No answer

How did you hear about this site? Check any that apply   Links from other sites Word of mouth Presentations in my workplace Print publications Radio Other

Where are you visiting us from? Choose one of the following answers Newfoundland Nova Scotia PEI New Brunswick Quebec Ontario Manitoba Saskatchewan Alberta British Columbia Yukon Northwest Territories Nunavut Outside Canada No answer

Please help us build a profile about our users by telling us about your gender and age. Please remember, your answers are completely anonymous. Your gender Female Male No answer

Your age in years Choose one of the following answers 14 or under 15 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80 - 84 85 or over No answer