JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
1-Minute Diet Questionnaire
Take a Moment to Reflect on Your Diet and Food Preferences.
We’ll email you a copy of your responses—your email won’t be used for marketing.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Brought to you by
Do you avoid ultra processed foods?
*
Choose
Always
Often
Rarely
Never
Do you avoid foods with added sugar?
*
Choose
Always
Often
Rarely
Never
Do you choose organic foods when possible?
*
Choose
Always
Often
Rarely
Never
Do you include a variety of fruits and vegetables in your meals each week?
*
Choose
Always
Often
Rarely
Never
Do you check ingredient and nutrition labels before buying packaged foods?
*
Choose
Always
Often
Rarely
Never
How familiar are you with the nutritional differences between various natural foods, such as kale vs. celery or walnuts vs. cashews?
*
Choose
Very familiar
Somewhat familiar
Slightly familiar
Not at all familiar
What are your go-to meal, snack, and drink?
*
Your answer
Do you eat at restaurants mainly for taste, convenience, cost, or other reasons?
*
Your answer
What questions, comments, or thoughts you’d like to share?
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Cudos Kids.
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report