Food Frequency Questionnaire
Disclosure: The following Food Frequency Questionnaire has been adapted from the National Institute of Health’s Diet History Questionnaire (DHQIII). To simplify this questionnaire and help Nutrition Coaches remain within their scope of practice, vitamin and mineral supplement questions have been omitted. This questionnaire is for informational and nutrition coaching purposes and is not intended to diagnose illness or prescribe nutritional therapy.


Instructions: Answer the following questions to the best of your ability. It is important, for the accuracy of this questionnaire, to answer each question truthfully. Questions are broken into major categories similar to the DHQIII. If a question does not apply to you or you simply do not consume the food or drink in question, leave the associated answer fields blank.
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Beverages
If you've consumed the item within the last 12 months; check one (rarely/sometimes/consistently) and check one (small/medium/large).
Untitled Question
Rarely
Sometimes
Consistently
Small
Medium
Large
Tomato juice or vegetable juice
Orange juice or grapefruit juice
Grape juice
Other 100% fruit juices (ex. apple)
Fruit or vegetable smoothies
Boxed fruit drinks
Milk as a beverage
Milkshakes
Meal replacement or high-protein beverages
Soda or pop
Sports drinks
Energy drinks
Water
Vitamin enhanced water
Beer
Wine or wine cooler
Liquor or mixed drinks
Coffee (NOT including espresso drinks such as latte, mocha, etc.)
Espresso drink mixtures (including latte, mocha, cappuccino, etc.)
COLD or ICED tea (caffeinated or decaffeinated)
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