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Diet & Nutrition Survey Template
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Thank you for taking part in this diet and nutrition survey. Your answers will help us understand eating habits, nutritional needs, and wellness goals. All responses are anonymous and will be kept confidential.
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1. How would you describe your current eating style?
Balanced diet (vegetables, fruits, protein, whole grains)
High-protein, low-carb
Vegetarian
Vegan
Flexible / No specific diet
Processed food / Fast food heavy
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2. How many meals do you typically eat per day?
2 meals
3 main meals
3 meals + 1–2 snacks
Irregular meals
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3. How often do you eat fresh fruits and vegetables?
Every day
4–5 times a week
2–3 times a week
Rarely or never
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4. How often do you consume sugary drinks (soda, sweetened coffee, energy drinks)?
Never
Once a week or less
2–3 times a week
Daily
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5. What is your main nutrition or health goal?
Weight loss
Muscle gain / Fitness
Better energy levels
Improve digestion
Maintain current health
No specific goal
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6. How often do you read nutrition labels on food packages?
Always
Often
Sometimes
Rarely
Never
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7. Do you take any dietary supplements?
Multivitamins
Protein powder
Omega‑3 / Fish oil
Probiotics
No supplements at all
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8. How would you rate your overall water intake?
Very good (8+ cups daily)
Good (5–7 cups daily)
Average (3–4 cups daily)
Poor (less than 3 cups daily)
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9. How often do you eat home‑cooked meals?
Every day
Most days
Sometimes
Rarely
Almost never
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10. What is the biggest challenge to maintaining a healthy diet?
Lack of time
High cost of healthy food
Cravings for junk food
Lack of nutrition knowledge
Busy schedule
No major challenges
Other (Please specify)
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