Survey on Food Habits
Who shops for food at your home?
_____ Dad _____ Mom _____ Brother ______ Sister _____ Other
Who prepares it?
_____ Dad _____ Mom _____ Brother ______ Sister _____ Other
What kind of meat do you usually eat the most?
___Steaks ____pork chops ____ chicken ____fish
What type of meal or meals do you prepare most often?
___ Fried ___ baked ___ broiled ___ stewed/slow cooked ___ grilled
How many meals do you have a day?
____ 1 ____ 2 ____ 3 ____ 4 _____ 5 _____ 6
Do you take your time while eating?
____ Always _____ sometimes _____ rarely _____ never
How often do you eat breakfast?
____ Every day _____ 3 to 6 times a week ____ once in a while ____ never
Do you usually have a fruit in your meals?
____ Yes ____ No
How often do you eat junk food?
____ Always _____ sometimes _____ rarely _____ never
How many caffeinated drinks (soda, coffee) do you have every day?
____ None ____ 1 ____ 2 to 3 ____ 3 and more
How many glasses of water do you drink every day?
____ None ____ 1 _____ 2 to 3 _____ 4 to 6
How do you prepare rice at home?
______ parboiled ______ fried
How do you prepare meats at home?
____ Fried ____ baked _____ stewed _____ grilled
Do you like vegetables?
______ Yes ______ No
Do you add salt to your foods when you cook?
____Yes ____ No