Eating Habits Questionnaire
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Email *
As best as you can remember right now, tell me generally about an average day of eating and drinking. This doesn’t have to be perfect; just capture your usual patterns. (Time, then what it is you eat) *
Right now, are you following any particular diet or style of eating? (e.g., vegetarian / vegan, Paleo, kosher / halal, low-carb) If yes, what? And for how long have you followed this way of eating? *
What are some of the foods or meals you like MOST? *
What are some of the foods or meals you DON’T like? *
Right now, on a scale of 1-10, how consistent would you say you are with your eating habits? *
All over the place
Perfectly consistent all the time
If you’re less consistent than you’d like to be, what seems to get in the way or knock you off track? *
Do you have any known / diagnosed food allergies or intolerances? If yes, what are those? *
Do you have any suspected or possible food allergies or intolerances? If yes, what are those? *
Do you have any digestive system complaints right now? If yes, what are those? *
On a scale of 1-10, how would you describe your normal appetite / hunger? *
Never hungry
Always starving/ravenous
Do you feel like you have trouble controlling your appetite / hunger? *
Do you normally struggle with food cravings? *
If yes or sometimes, what do you normally crave? *
What do you normally do when you have cravings? *
How often do you normally make meals at home? *
How often do you normally eat meals in restaurants / cafeterias? *
On a scale of 1 to 10, how would you rank your food preparation and cooking skills right now? *
Terrible/nonexistent
Expert Chef
Do you like cooking? *
If no, what do you NOT like? *
If yes or sometimes, what do you enjoy about it? *
Thinking about all that you have written down here, what do you think you might like to start working on or addressing first? *
A copy of your responses will be emailed to the address you provided.
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