By Lynn Rohrs, Lead Consultant, Academic Information Systems, Columbia University.
Thank you for agreeing to participate in this study. Please be assured that your identity will be carefully guarded, we use your name on this form only for administrative purposes.
ID Number ________________
Age: ___________ Weight: ___________
How many years have you been overweight? ______________
Starting Ending Weight ____________ _____________ Pulse Rate ____________ _____________ Skinfold ____________ _____________
______________ (1=low through 5=high)
Return to Creating Data.