21/01/2025, 21:26 Lifestyle and Dietary Habits Impact on Health Survey
Lifestyle and Dietary Habits Impact on
Health Survey
This survey aims to analyze the relationship between lifestyle choices, dietary habits, and
overall health. By gathering information on factors such as diet type, exercise levels, and
health conditions, we hope to uncover patterns that influence physical well-being.
The insights from this survey will be used for research and educational purposes to
promote healthier living practices. Your responses will remain confidential and will only
be used for my Undergraduate Project.
The survey will take approximately 5-10 minutes to complete. Your participation is highly
valued and appreciated!
* Indicates required question
1. What is your age? *
2. What is your gender? *
Mark only one oval.
Male
Female
Other
3. Which region in India do you currently reside in? *
Mark only one oval.
East
North
South
West
Central
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21/01/2025, 21:26 Lifestyle and Dietary Habits Impact on Health Survey
4. What best describes your diet type? *
Mark only one oval.
Vegetarian
Non-Vegetarian
Vegan
5. What type of cuisine do you primarily consume?( *
eg. Punjabi,Gujarati,Maharashtrian,South Indian,Rajasthani,Bengali,etc)
6. What level of spice do you generally prefer in your meals?
Mark only one oval.
Low
Medium
High
7. How would you rate your daily sugar intake? *
Mark only one oval.
Low
Moderate
High
8. How would you rate your daily salt intake? *
Mark only one oval.
Low
Moderate
High
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21/01/2025, 21:26 Lifestyle and Dietary Habits Impact on Health Survey
9. Do you smoke?
Mark only one oval.
Yes
No
10. How often do you consume alcohol? *
Mark only one oval.
Yes
No
11. Have you been diagnosed with diabetes? *
Mark only one oval.
Yes
No
12. Have you been diagnosed with hypertension (high blood pressure)? *
Mark only one oval.
Yes
No
13. Have you been diagnosed with any cardiac issues? *
Mark only one oval.
Yes
No
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21/01/2025, 21:26 Lifestyle and Dietary Habits Impact on Health Survey
14. How often do you engage in physical exercise? *
Mark only one oval.
Active
Moderate
Sedentary(not active)
15. What is your weight? *
16. What is your height? *
17. What is your estimated daily calorie intake? *
Mark only one oval.
Less than 1500 calories
1500–2000 calories
2000–2500 calories
More than 2500 calories
18. How many meals do you typically consume in a day? *
Mark only one oval.
1–2
3–4
5 or more
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21/01/2025, 21:26 Lifestyle and Dietary Habits Impact on Health Survey
19. How would you describe the overall impact of your diet on your health?
Mark only one oval.
Positive
Neutral
Negative
20. On a scale of 1 to 10, how would you rate your overall health? *
Mark only one oval.
0-3
4-6
7-8
9-10
This content is neither created nor endorsed by Google.
Forms
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