1. What does “eating healthy mean to you? (Check all that apply)
Low calorie foods
Organic/ Natural foods
2. How important is it to you to eat healthy?
Very Important Somewhat Important Not at all important
3. Are you vegetarian or vegan?
4. Do you have any other specific dietary needs?
5. Do you intake any dietary supplements?
Vitamins (e.g. vitamin D necessary for bone strength) Minerals (for e.g. calcium) Herbs
6. Do you eat the following:
Breakfast Lunch Dinner Snacks
7. Do you eat from all subdivisions of the food pyramid?
Grains Meat/ Fish/ Poultry Fruit Vegetables Dairy
8. What type of meal or meals do you prepare most often?
Fry Bake Broil Stew/slow cook Grill
9. Do you consume healthy or unhealthy snacks?
Healthy (fruits, no preservatives fruit juice, nuts, cheese, low sugar content biscuits or fruit bars etc.
Unhealthy (chips, croissants, soft drinks, high sugar content biscuits, chocolate etc.)
If other please specify:
10. How many glasses of water do you drink each day:
>8 or = 8 <8 <4 <2
11. What type of drink do you prefer?
Water Fruit Juice (No preservatives and low sugars) Soft Drinks (Carbonated)
12. Do you eat a larger amount of healthier food than junk food?
13 Do you eat the following regularly?
Takeaway Fast Food
14 Do you drink milk?
Plain (High in Calcium) Flavoured
15 How do you scale or classify against the healthy weight range of BMI