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Do you eat fruit 3 at  least 3 servings of fruit a day?
 
Yes
 
No
 
 
 
Do you eat at least 3-4 servings of vegetables a day?
 
yes
 
No
 
 
 
how many days a week do you eat fried foods?
 
1-2 days a week
 
2-4 days a week
 
4-5 days a week
 
Never
 
 
 
Do you plan your meals weekly?
 
Yes
 
No
 
 
 
Do you eat healthy snacks daily?
 
Yes
 
No
 
 
 
How many soft drinks do you drink a week?
 
1-2
 
2-3
 
3-4
 
0
 
 
 
How many days a week do you cook?
 
1-2
 
2-3
 
3-4
 
5-7
 
 
 
How much water do you drink daily?
 
8-16oz
 
16-24oz
 
24-32oz
 
more
 
 
 
How often do you eat food you know is bad for you
 
1-2 days a week
 
2-3 days a week
 
3-4 days a week
 
all week
 
 
 
Do you think your diet affects your health?
 
Yes
 
No
 
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