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Eating Habits Survey
Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.
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Eating Habits Survey
1
How often do you eat fruits and vegetables in a day?
Select the option that best describes your daily intake
Less than 1 serving
1-2 servings
3 or more servings
2
Rate your overall diet on a scale of 1 to 10
1 being poor and 10 being excellent
3
Describe your typical breakfast, lunch, and dinner
Please provide a brief description of your main meals
4
Do you consume sugary drinks regularly?
Choose yes if you drink sugary beverages like soda or sweetened juices frequently
Yes
No
5
How often do you eat fast food in a week?
Select the frequency of your fast food consumption
Never
1-2 times
3 or more times
6
Are you mindful of portion sizes when eating a meal?
Portion control helps in maintaining a balanced diet
Yes, I watch my portions
No, I do not pay attention to portion sizes
7
How many glasses of water do you drink in a day?
Choose the range that is closest to your daily water intake
Less than 4 glasses
4-8 glasses
More than 8 glasses
8
Do you read food labels before purchasing products?
Nutritional labels provide important information about the product
Always
Sometimes
Never
9
How often do you include whole grains in your diet?
Whole grains are beneficial for a balanced diet
Rarely or never
Sometimes
Frequently
10
Have you consulted a nutritionist or dietitian in the past year?
Professional advice can help in creating a balanced diet plan
Yes
No
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