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  5. Nutrition Survey
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What does being a healthy person mean to you?
   
 
 
 
How often do you conduct surveys?
 
Extremely healthy
 
Fairly healthy
 
Neutral
 
Fairly unhealthy
 
Unhealthy
 
 
 
What does a balanced diet mean to you?
   
 
 
 
I follow a balanced diet: (Strongly agree 1 to strongly disagree 7)
 
1
 
2
 
3
 
4
 
5
 
6
 
7
 
 
 
Indicate the amount of color you usually see on your plate during meals
 
Lots of color
 
A fair amount of color
 
A little bit of color
 
No color
 
 
 
What is important to you in a meal? (Check all that apply)
 
Taste
 
Amount of fat
 
Amount of carbohydrates
 
Amount of calories
 
Quantity
 
Other
 

 
 
 
How frequently do you find yourself snacking?
 
Always
 
Often
 
Sometimes
 
Rarely
 
Never
 
 
 
Please rate the healthiness of your snacks.
 
Healthy
 
Fairly Healthy
 
Neutral
 
Fairly Unhealthy
 
Unhealthy
 
 
 
I pay attention to my portion size.
 
Strongly Agree
 
Agree
 
Neutral
 
Disagree
 
Strongly Disagree
 
 
 
Do your friends or the people you eat with affect your food choices? (Strongly agree 1 to Strongly disagree 7)
 
1
 
2
 
3
 
4
 
5
 
6
 
7