This free survey is powered by QUESTIONPRO.COM
  1. Surveys
  2. 2011
  3. May
  4. H
  5. Health Survey 1
0%
Exit Survey »
 
 
On a scale of 1 to 10, 1 being the least healthy and 10 being the most healthy, how would you rank your diet?
 
1
 
2
 
3
 
4
 
5
 
6
 
7
 
8
 
9
 
10
 
 
 
What do you typically eat for breakfast? If it varies, please list all possibilities.
   
 
 
 
What do you typically eat for lunch? If it varies, please list all possibilities.
   
 
 
 
What do you typically eat for dinner? If it varies, please list all possibilities.
   
 
 
 
What snacks or drinks do you consume on a regular basis?
   
 
 
 
Which of these foods would you eat raw?
 
Fruits
 
Vegetables
 
Eggs
 
Red meat
 
Fish
 
Milk (unpasteurized)
 
Cheese (unpasteurized)

 
 
 
Which of these are you?
 
I eat everything
 
I'm vegetarian
 
I'm vegan
 
I'm pescetarian
 
Other
 
 
 
If answered Other to previous question, explain:
   
 
Survey Software Powered by QuestionPro Survey Software