Healthy Eating Survey
How many meals do you have a day generally?
1
2
3
4
5+
What meals do you eat in a day?
Breakfast
Brunch
Elevenses
Lunch
Supper
Dinner
Other
Please rate how strongly you agree or disagree with each of the statements.
Rows
Totally Disagree
Disagree
Agree
Totally Agree
N/A
I always eat home-made food.
1
2
3
4
5
I frequently eat fast food. (i.e burgers, fries, pizza, etc)
6
7
8
9
10
I often have a late night snack/meal. (past 10pm)
11
12
13
14
15
My late night snacks/meals always healthy.
16
17
18
19
20
I choose heathy food over fast food.
21
22
23
24
25
I often drink 2 liters of water a day.
26
27
28
29
30
I often drink soda/alcoholic beverages.
31
32
33
34
35
I frequently skip breakfast.
36
37
38
39
40
I always pay attention to the nutrition facts of food products before consuming them.
41
42
43
44
45
I eat more when stressed.
46
47
48
49
50
I am a picky eater.
51
52
53
54
55
What is the longest time you normally go without eating between meals?
Hour Minutes
Have you ever been diagnosed by your doctor as any of the following?
Underweight
Normal Weight
Overweight
Obese
Your Gender
Female
Male
Prefer not to answer
Other
Your Age
Submit
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