Food Consumption Assessment
Think about what you eat during an average week as you respond.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Group ID
How often do you eat fried foods?
Not at all
1
2
3
4
5
6
7
8
9
Almost every day
10
1 is Not at all, 10 is Almost every day
How often do you eat salad dressing, mayonnaise, oil or margarine?
Not at all
1
2
3
4
5
6
7
8
9
Almost every day
10
1 is Not at all, 10 is Almost every day
How often do you add salt or soya sauce or other salts to your food?
Not at all
1
2
3
4
5
6
7
8
9
Almost every day
10
1 is Not at all, 10 is Almost every day
How often do you eat meat products including chicken or eggs?
Not at all
1
2
3
4
5
6
7
8
9
Almost every day
10
1 is Not at all, 10 is Almost every day
How often do you eat fast, deli or restaurant foods?
Not at all
1
2
3
4
5
6
7
8
9
Almost every day
10
1 is Not at all, 10 is Almost every day
How often do you eat canned, boxed, or frozen foods?
Not at all
1
2
3
4
5
6
7
8
9
Almost every day
10
1 is Not at all, 10 is Almost every day
How often do you eat sweet treats?
Not at all
1
2
3
4
5
6
7
8
9
Almost every day
10
1 is Not at all, 10 is Almost every day
How often do you eat homemade meals?
Not at all
1
2
3
4
5
6
7
8
9
Almost every day
10
1 is Not at all, 10 is Almost every day
How often do you eat beans or peas, oats or brown rice?
Not at all
1
2
3
4
5
6
7
8
9
Almost every day
10
1 is Not at all, 10 is Almost every day
How often do you eat fresh fruits?
Not at all
1
2
3
4
5
6
7
8
9
Almost every day
10
1 is Not at all, 10 is Almost every day
How often do you eat bread, bagels, biscuits or pancakes?
Not at all
1
2
3
4
5
6
7
8
9
Almost every day
10
1 is Not at all, 10 is Almost every day
How often do you eat pasta or pizza?
Not at all
1
2
3
4
5
6
7
8
9
Almost every day
10
1 is Not at all, 10 is Almost every day
How often do you consume milk, cheese, creamers, yogurt, or ice cream?
Not at all
1
2
3
4
5
6
7
8
9
Almost every day
10
1 is Not at all, 10 is Almost every day
How often do you eat fresh salads or vegetables?
Not at all
1
2
3
4
5
6
7
8
9
Almost every day
10
1 is Not at all, 10 is Almost every day
How often do you drink sodas, juice or sweet tea?
Not at all
1
2
3
4
5
6
7
8
9
Almost every day
10
1 is Not at all, 10 is Almost every day
How often do you drink caffeinated coffee/drinks?
Not at all
1
2
3
4
5
6
7
8
9
Almost every day
10
1 is Not at all, 10 is Almost every day
How often do you eat Crustaceans: crab, crayfish, lobster, shrimp, clams or scallops.
Not at all
1
2
3
4
5
6
7
8
9
Almost every day
10
1 is Not at all, 10 is Almost every day
Total Score
Total Score %
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