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Dietary Survey
Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.
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1
Do you follow a specific diet plan?
Please select the diet plan that best matches your current dietary habits.
Keto
Paleo
Vegetarian
Vegan
Mediterranean
Other
2
On a scale of 1 to 10, how satisfied are you with your current diet?
Rate your level of satisfaction with your diet, where 1 is very dissatisfied and 10 is very satisfied.
3
How many servings of fruits and vegetables do you typically eat in a day?
Please provide an estimate of the total servings of fruits and vegetables you consume daily.
4
What is your preferred source of protein?
Select the option that best represents your primary source of protein in your diet.
Meat
Fish
Eggs
Legumes
Nuts
Other
5
How often do you consume sugary beverages?
Indicate the frequency of consumption of drinks high in sugar.
Daily
A few times a week
Rarely
Never
6
What is your attitude towards processed foods?
Select the option that best describes your view on processed foods.
Avoid completely
Limit consumption
Moderate consumption
No restriction
7
How often do you eat out or order takeout in a week?
Indicate the frequency of dining out or ordering takeout meals per week.
Almost every day
A few times a week
Rarely
Never
8
What is your main reason for choosing the foods you eat?
Select the primary factor influencing your food choices.
Taste
Health benefits
Convenience
Ethical reasons
Other
9
How often do you read nutritional labels before purchasing food products?
Indicate how frequently you check nutritional information on packaged foods.
Always
Sometimes
Rarely
Never
10
Would you like to receive personalized dietary recommendations based on your responses?
Indicate if you are interested in receiving personalized dietary advice.
Yes
No
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