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24-Hour Nutrition Recall Survey

Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.

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1

What did you have for breakfast yesterday?

Please select the option that best describes your breakfast.
2

Rate your overall satisfaction with yesterday's lunch on a scale of 1 to 10

Please rate your satisfaction level with yesterday's lunch.
3

Please describe the snacks you consumed throughout the day

Please provide a detailed description of the snacks you had during the day.
4

Which beverages did you drink the most yesterday?

Please select the beverage that you consumed the most yesterday.
5

How many servings of fruits and vegetables did you have in the past 24 hours?

Please enter the total number of servings of fruits and vegetables.
6

Did you have a balanced dinner last night?

Please indicate if you had a balanced dinner last night.
7

On a scale from 1 to 5, how would you rate the nutritional value of the meals you had yesterday?

Please rate the nutritional value of your meals from 1 (low) to 5 (high).
8

Which meal did you enjoy the most in the past 24 hours?

Please select the meal that you enjoyed the most in the past 24 hours.
9

Do you have any dietary restrictions or food allergies that affect your food choices?

Please provide details of any dietary restrictions or food allergies you have.
10

How many glasses of water did you drink in the last 24 hours?

Please enter the total number of glasses of water you consumed.
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