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If you do not have a paid job, which of the following reasons is most applicable to your situation?

Do you smoke?

Number of cigarettes a day

Number of packages of pipe tobacco a week

How long has it been since you've quit drinking alcohol?

Number of glasses of wine or port wine per week

Can you indicate in the table below how many hours you have spend on average on a weekly basis on the following activities in the past summer and winter. This concerns activities outside your (un)paid work. If one type of activity does not apply, enter '0 '.

How many times did you have contact with your general practitioner in the past 12 months?

How many times did you have contact with your specialist in the past 12 months?