Public Dietary Habits Questionnaire
Help us understand general dietary patterns by answering the following questions about your eating habits.
Age
*
Gender
*
Male
Female
Non-binary
Prefer not to say
How many meals do you typically eat per day?
*
1
2
3
More than 3
How often do you consume the following foods?
*
Rows
Never
Rarely
Sometimes
Often
Daily
Fruits
1
2
3
4
5
Vegetables
6
7
8
9
10
Whole grains
11
12
13
14
15
Dairy products
16
17
18
19
20
Red meat
21
22
23
24
25
Fish/Seafood
26
27
28
29
30
Fast food
31
32
33
34
35
Sugary drinks
36
37
38
39
40
Do you follow any specific diet?
*
Vegetarian
Vegan
Gluten-free
Low-carb
No specific diet
Other
How many glasses of water do you drink per day?
*
Please Select
Less than 2
2-4
5-7
8 or more
How often do you snack between meals?
*
Never
Rarely
Sometimes
Often
What are your most common reasons for choosing certain foods? (Select all that apply)
*
Taste
Convenience
Cost
Health benefits
Cultural/religious reasons
Other
How would you rate your overall diet quality?
*
1
2
3
4
5
Please share any additional comments about your eating habits.
Submit
Should be Empty: