Eating Habits Questionnaire
Name
First Name
Last Name
Gender
Age
Height
Weight
How many meals do you eat away from home on weekdays?
Rows
How many
Breakfasts
Lunches
Dinners
How many meals do you eat away from home on weekends?
Rows
How many
Breakfasts
Lunches
Dinners
Please indicate your meal time of the last 3 days
How often do you eat hot meals?
Rows
None
1-3 times per week
3-5 time per week
Once a day
Several times a day
During weekdays
1
2
3
4
5
During weekends
6
7
8
9
10
Responsiveness
11
12
13
14
15
Friendliness
16
17
18
19
20
Do you eat at nights?
Yes
No
How much coffee/ tea do you drink a day?
None
1-2 cups per day
3-4 cups per day
5-6 cups per day
More than 4 cups
How many alcoholic drinks do you have in a week where a standard drink is one of 1dL of wine, 3dL of beer, 2 cL of liquors?
None
1-3 standard drinks a week
4-7 standard drinks a week
8-12 standard drinks a week
More than 12 standard drinks a week
How often do you eat in a restaurant?
None
1-2 times per week
3-4 times per week
5-6 times per week
More than 7 times per week
Do you watch out to eat healthy?
Yes
No
What type of food do you buy?
Fresh foods
Pre-cooked foods
Canned foods
Frozen foods
Other
What do you do for living?
How many hours do you approximately seat in a day?
How many hours do you approximately stand in a day?
How many hours do you approximately walk in a day?
How many hours do you approximately run in a day?
How many hours do you approximately rest in a day?
How many hours do you approximately sleep in a day?
Any comments that you would like to add
Submit
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