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Nutrition and Eating Habits Survey

The information you provide here will remain anonymous and will be used to help us refine our services and goals. You are not required to answer every question or fill every field. When you are satisfied with your responses, click the "Submit" button at the end of the survey.

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The entire survey takes about 8-10 minutes to complete.

What is your gender?
What is your age?
Which of the following best describes you?
Marital Status
Number of children under the age of 18
Employment status
Do you take any prescription medications?
Do you take any dietary supplements?
Do you monitor/track your calorie intake?
Do you have any food allergies?
Have you ever been diagnosed with diabetes?
Have you ever been diagnosed with high blood pressure?
Have you ever tried any of the following diets? (select all that apply)
How long have you been able to maintain a special diet?
Do you enjoy a wide variety of foods?
Do you enjoy trying new foods?
How many meals a day do you consume?
How many times a day do you snack?
How often do you prepare meals for your household?
Which meals do you normally prepare for yourself or your household? (select all that apply)
How much thought do you put into meal planning?
How often do you eat fast food or at a restaurant?
How often does the cost of food hinder your ability to make healthier food choices?
How often do you choose to eat fast food or at a restaurant because you don't have time to prepare your own meals?
How often do you eat in the car or while driving?
How often do you sit down with others to share a meal?
How often do you eat while watching television, while online, or while interacting with other forms of media?
How many 1 cup servings of fruits and vegetables do you consume daily?
Do you prefer foods that are labled "organic"?
Do you monitor your sodium intake?
Do you try to maintain a high protein diet?
About how many glasses of water do you consume a day?
Do you consume 20 or more ounces of the following each day? (select all that apply)
How often do you consume energy drinks such as Red Bull and Monster?
About how many cups of coffee do you consume a day?
Are there any foods that you avoid for health reasons?
About how many hours do you sleep a night?
Do you take naps during the day?
How often do you exercise?
About how much time a day do you spend exercising?
How intense is your average exercise session?
Do you enjoy exercise?
Would you consider maintaining healthy eating habits more or less important than exercising regularly?
How often do you weigh yourself?
Do you have a tendency to eat when you are upset?
Do you have a tendency to feel guilt after overeating?
Are there certain foods that cause you to feel guilt after eating them?
Do you have a tendency to eat as a means of comfort?
Do you tend to become irritable after missing a meal?
Are there any foods you find it difficult to stop eating once you've started?
Are you satisfied with your current weight?
Would you say you have a positive body image?
Do you know how to read nutrition facts labels?
Would you consider yourself educated/informed when it comes to nutrition and dieting?
How much do you use social media for health and wellness information and education?
How often do you read books about food and nutrition?
Do you currently have any health conditions that might be improved or treated through adjustments in diet and eating habits?
Have you ever been concerned that your diet and/or eating habits might be negatively impacting your health?
If you could make improvements to your overall health and quality of life through adjustments in diet and eating habits, how motivated would you be to do so?
Have you ever considered consulting a dietitian or nutritionist?

You have reached the end of the Survey. Please submit your answers using the "submit" button below.

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