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Food Habits Survey
Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.
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1
gender
male
female
other
2
what is you're age
18-22
23-27
27-35
36-49
49-65
65+
3
what is your weight
in any measurement(pounds ,kilo ,stone) Ranges are ok
4
What is your height
any measurement
5
How many times a week do you deliver or eat out?
Please select the option that best represents your frequency.
1 to 2
3 to 4
5 to 6
6 to 7
6
In the days you don't eat out or deliver, what do you usually consume?
Please select the option that corresponds to your usual choice.
Home cooked
Ready meals
Both but mostly home cooked
Both but mostly ready meals
7
How many meals do you eat a day?
Select one answer
1
2
3
4
5
6+
8
Do you skip breakfast?
Please select yes or no.
Yes
No
9
Why do you skip breakfast?
answer only if you said yes to previous question
to save time
to save money
fasting or other other dietary methods
cant remember the last time i did
10
when you do order, what category does the food fall under?
Please select the category that best describes your food choices.
fast food chain
street
restaurant
local takeout shops
11
how many times a week do you take part in some form of exercise
Select one answer
never
1 or 2
3 or 4
5 or 6
every day
12
Additional Comments:
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