Nutrition Behavior Change Motivation Survey
Please answer the following questions about your nutrition habits and motivation to change.
How motivated are you to improve your nutrition habits?
1
1
2
3
4
Best
5
1 is , 5 is Best
Which of the following factors motivate you to change your nutrition behavior?
Option 1
Option 2
Option 3
How often do you consume fruits and vegetables per day?
Option 1
Option 2
Option 3
How often do you eat fast food or processed food?
Option 1
Option 2
Option 3
What barriers do you face in changing your nutrition behavior?
Option 1
Option 2
Option 3
Please describe any additional thoughts or challenges you have regarding nutrition behavior change.
Submit
Should be Empty: