Eating and dietary habits questionnaire template

Hello,

Please take a few minutes of your time to fill in the following survey.

1. How many times a day do you eat?

  • Choose...
    • Choose...
    • 1x
    • 2x
    • 3x
    • 4x
    • 5x
    • More

2. Please answer the following according to your particular eating habits?

  • Yes
  • Sometimes
  • No

I eat a good breakfast

  • Yes
  • Sometimes
  • No

I experience feelings of hunger during the day

  • Yes
  • Sometimes
  • No

I eat meat

  • Yes
  • Sometimes
  • No

I eat vegetables

  • Yes
  • Sometimes
  • No

I eat fruit

  • Yes
  • Sometimes
  • No

I eat dairy

  • Yes
  • Sometimes
  • No

I eat sweets

  • Yes
  • Sometimes
  • No

3. What meal would you consider to be your main meal of the day?

  • Breakfast
  • Lunch
  • Dinner

4. What does your main meal consist of and how is it prepared?

  • Freshly home-cooked produce
  • Restaurant meal
  • Pre-cooked, microwave or TV dinners

5. What does your main meal on the weekend consist of and how is it prepared?

  • Freshly home-cooked produce
  • Restaurant meal
  • Pre-cooked, microwave or TV dinners

6. Have you been avoiding some foods for health reasons?

  • No

7. Do you have any particular food allergies?

  • No

8. What is your weekly food intake frequency of the following food categories?

  • Several times a day
  • Once a day
  • Several times a week
  • Less often
  • Never

Sweet foods

  • Several times a day
  • Once a day
  • Several times a week
  • Less often
  • Never

Salty foods

  • Several times a day
  • Once a day
  • Several times a week
  • Less often
  • Never

Fresh fruit

  • Several times a day
  • Once a day
  • Several times a week
  • Less often
  • Never

Fresh vegetables

  • Several times a day
  • Once a day
  • Several times a week
  • Less often
  • Never

9. What percentage of your regular diet consists of meat and meat products?

  • 90% or more
  • 75%
  • 50%
  • 25%
  • Less than 25%

10. How much of your diet consists of vegetables and non-animal products?

  • 90% or more
  • 75%
  • 50%
  • 25%
  • Less than 25%

11. Do you or have you ever had cholesterol problems?

  • Yes
  • No
  • I don't know

12. Do you know your current BMI (Body Mass Index) index?

  • Less than 18,5 (Underweight)
  • 18,5-25 (Ideal weight)
  • 25-30 (Overweight)
  • 30-35 (Moderate obesity)
  • 35-40 (Obesity)
  • More than 40 (Morbidly obese)
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Eating and dietary habits survey

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What are the public’s eating habits? How many meals in what daily amount meet the standard? The eating habits questionnaire template will provide answers.

Use template — it’s free

The survey sample is ideal for

  • nutritional consultants,
  • students or journalists,
  • operators of restaurants and fast food.

If you are interested in or work directly in the field of nutritional counselling and observe differences in attitudes to eating, types of preferred diet or methods of consumption, then without hesitation, use the eating habits questionnaire template. The answers to these questions can serve as a starting point before the consultation visit. A larger sample of respondents will then offer a basis for the elaboration of a study, seminar work and newspaper articles on the topic of eating.

The questionnaire template can be fully edited. Survio will process your answers into well-arranged tables and graphs.

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