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How often do you consume chocolate?
 
Every day
 
Every two or three days
 
Every five or six days
 
Every week or two
 
Monthly
 
I do not eat chocolate
 
 
 
What's your favorite type of chocolate?
 
Milk
 
Dark
 
White
 
Chocolate with extras (nuts, caramels, peanut butter, etc.)
 
I do not eat chocolate
 
 
 
Do you consume chocolate when you feel emotional?
 
Yes
 
No
 
I do not eat chocolate
 
 
 
I consume chocolate when I feel (Select all that apply):
 
Happy
 
Sad
 
Stressed
 
Angry
 
Anxious
 
Bored
 
I do not eat chocolate

 
 
 
In the midst of experiencing relational problems (with family, friends, or a significant other), have you ever consumed chocolate?
 
Yes
 
No
 
I do not eat chocolate
 
 
 
What is your age?
 
15-24
 
25-34
 
35-44
 
45-54
 
55-64
 
65-74
 
 
 
What is your gender?
 
Male
 
Female