Skip to content
Askalot

← All Other templates

Questionnaire template

Nutrition Habits and Knowledge Check

Adults report eating habits, readiness to change diet and label use, and answer two basic nutrition knowledge items.

Preview

Other · Quiz. All Other templates

Questions in this template

How You Eat

  1. This short check asks about your eating habits and tests a little nutrition knowledge. It takes about five minutes.

  2. In a typical week, how many times do you eat a meal away from home?

    Choose one:

    • Never
    • 1-2 times
    • 3-5 times
    • More than 5 times

  3. Which best describes the way you eat?

    Choose one:

    • Vegan
    • Vegetarian
    • Pescatarian
    • Omnivore
    • Other

  4. Please describe the way you eat.

    Condition: Only when 'Other' was chosen

    Open answer

Test Your Knowledge

  1. Which macronutrient provides most of the energy in fruit and vegetables?

    Choose one:

    • Protein
    • Fat
    • Carbohydrate
    • Not sure

  2. Which of these foods are good sources of healthy, unsaturated fats? Select all that apply.

    Choose any that apply:

    • Avocado
    • Butter
    • Olive oil
    • Walnuts
    • Not sure

Changing Your Diet

  1. How willing are you to change your diet for health reasons?

    Choose one:

    • 1 - Not at all willing
    • 2
    • 3
    • 4
    • 5 - Extremely willing

  2. What is the main reason you would change your diet?

    Condition: Only for respondents with some willingness to change

    Open answer

Food Labels

  1. When you buy groceries, how often do you read the nutrition labels?

    Choose one:

    • Always
    • Often
    • Sometimes
    • Rarely
    • Never

  2. What do you usually look at on a label? Select all that apply.

    Condition: Only for respondents who read labels

    Choose any that apply:

    • Calories
    • Sugar
    • Salt
    • Fat
    • Ingredients list
    • Allergens