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Eating Habits Questionnaire

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Porkodi Sengodan
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26 views

Eating Habits Questionnaire

Uploaded by

Porkodi Sengodan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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10/9/24, 12:41 AM Eating Habits Questionnaire

Eating Habits Questionnaire

Name

First Name Last Name

Gender Age

ex: 23

Height Weight

ex: 1.7 m ex: 170 lb

How many meals do you eat away from home on weekdays?

How many

Breakfasts

Lunches

Dinners

How many meals do you eat away from home on weekends?

How many
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10/9/24, 12:41 AM Eating Habits Questionnaire

Breakfasts

Lunches

Dinners

Please indicate your meal time of the last 3 days

Check Box Radio Buttons Text Area Drop down

one one Hint Text Please Select


two two

three three

Calendar

How often do you eat hot meals?

1-3 times per 3-5 time per Once a Several times a


None
week week day day

During
weekdays

During
weekends

Responsiveness

Friendliness

Do you eat at nights?

Yes No
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10/9/24, 12:41 AM Eating Habits Questionnaire

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?

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10/9/24, 12:41 AM Eating Habits Questionnaire

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?

ex: 6

How many hours do you approximately stand in a day?

ex: 6

How many hours do you approximately walk in a day?

ex: 6

How many hours do you approximately run in a day?

ex: 6

How many hours do you approximately rest in a day?

ex: 6

How many hours do you approximately sleep in a day?


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10/9/24, 12:41 AM Eating Habits Questionnaire

ex: 6

Any comments that you would like to add

Submit

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