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Healthy eating habits
SURVEY CARD - EATING HABITS
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* Indicates required question
Where are you from?
*
Your answer
Gender ?
*
male
famale
Age?
*
14
15
16
17
18
What is the most special dish for Christmas in your country ?
*
Your answer
What is the most special dish for Easter in your country ?
*
Your answer
Do you have breakfast in the morning?
*
yes
no
sometimes
How often do you eat during the day?
*
Once
twice
three times
four times
five times or more
How often do you eat home-cooked food?
*
Daily
Once a week
2-3 times a week
2-3 times a month
What type of fat do you use most often for home cooking? ( please provide only one answer )
*
Vegetable oil / oil /
Margarine
Butter
What type of fat do you use most often to spread on bread?
*
Plain margarine
Low fat margarine
Butter
Mass or other animal fats
I do not use
If you drink fresh cow's milk, what fat is it most often? ( please provide only one answer )
*
Whole milk ( by about 3.6% or more )
Low fat milk / about 2%
cSkimmed milk / by about 1.5%
I don't drink milk
Do you put salt in the food extra
*
Yes, when it's not salty enough
Almost always before I try
Never
Do you follow a diet?
*
Yes, at my request
Yes, recommended by a doctor
No
How many cups of tea or coffee do you drink daily?
*
1
2
3
4
5
Tea
Coffee
1
2
3
4
5
Tea
Coffee
How many spoons or lumps of sugar do you use for a cup of coffee or tea?
*
1
2
3
lumps or spoons in a cup of coffee
lumps or spoons in a cup of tea
1
2
3
lumps or spoons in a cup of coffee
lumps or spoons in a cup of tea
How many slices of bread do you eat daily?
*
1
2
3
4
5
Rye bread
White bread
Other bread
1
2
3
4
5
Rye bread
White bread
Other bread
How often have you consumed the following foods and drinks in the last week?
*
Every day
1 - 2 times
3 - 5 times
6 -7 times
Milk
Yoghurt
Dairy products
Chicken
Red meat
Local products
Fish
Eggs
Cooking (beans, lentils )
Rice
Pasta
Cereals
Boiled potatoes
French fries
Fresh fruits
Compotes, juices, etc
Fresh vegetables
Canned vegetables
Biscuits, chocolate, etc.
Jars, sandwiches, etc.
Soft drinks
Every day
1 - 2 times
3 - 5 times
6 -7 times
Milk
Yoghurt
Dairy products
Chicken
Red meat
Local products
Fish
Eggs
Cooking (beans, lentils )
Rice
Pasta
Cereals
Boiled potatoes
French fries
Fresh fruits
Compotes, juices, etc
Fresh vegetables
Canned vegetables
Biscuits, chocolate, etc.
Jars, sandwiches, etc.
Soft drinks
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