Template 諮詢表格 健康習慣問卷模板

健康習慣問卷模板

健康習慣問卷模板

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Healthy Habits Questionnaire Template

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1.
Which kind of breakfast do you usually have?[多選題]
Cereal or pastries
Cooked breakfast (full English)
Coffee or tea only
Toast
Protein shake or smoothie
I skip breakfast
Other
2.
How often do you skip breakfast?[多選題]
Never
3 times or less per week
More than 3 times per week
Always
3.
Do you feel hungry or tired before lunchtime?[多選題]
Yes
No
4.
What do you typically eat for lunch?[多選題]
Fast food or meal deal
Packed lunch or sandwich
Fruit or yogurt
Cooked meal or salad
5.
On average, how long do your meals last?[多選題]
Less than 10 minutes
10–29 minutes
30–59 minutes
60 minutes or more
6.
How many times do you usually chew before swallowing?[多選題]
Fewer than 10 times
10 to 19 times
20 to 29 times
30 times or more
7.
When is your last meal relative to bedtime?[多選題]
Within 2 hours before sleeping
More than 2 hours before sleeping
8.
When do you stop eating during a meal?[多選題]
When about 80% full
When completely full (100% satiety)
9.
If you want a drink other than water, which would you choose?[多選題]
Green tea
Black tea or other tea
Coffee (without sugar)
Coffee (with sugar)
Juice (non-carbonated)
Carbonated drinks
10.
What do you use to sweeten food or drinks?[多選題]
Sugar
Other sweeteners
11.
How often do you snack after dinner?[多選題]
3 times or more per week
Less than 3 times per week
12.
How often do you exercise?[多選題]
Never
1-2 times a week
3-4 times a week
5-7 times a week
Other
13.
Would you describe your weight as:[多選題]
Underweight
Overweight
About right
Prefer not to answer
14.
Do you have any weight loss or health goals?[多選題]
Yes
No
Maybe
15.
Which goals do you want to achieve?[多選題]
Weight loss
Inch loss
Tone up
Build lean muscle mass
Get fitter
Other
16.
How would you describe your gender?[多選題]
Male
Female
Non-binary
I would like to skip this question
Prefer to self-describe
17.
What is your age group?[多選題]
18-29
30-39
40-50
Over 50
18.
Would you like to learn how we can help you reach your goals with a few small changes?[多選題]
Yes
No
Maybe
*
19.
Name
20.
Phone Number
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Template instructions
健康習慣問卷模板可幫助您收集有關個人飲食、鍛煉和日常生活的信息。使用此調查來評估健康行為,確定需要改進的領域,並支持學生、客戶或患者設定目標。

這個免費模板包括有關早餐習慣、膳食類型和持續時間、零食、飲料選擇、飽腹感提示、咀嚼頻率、運動頻率、體重感知和健康目標的問題。年齡和性別等人口統計項目以及聯繫人字段可讓您跟進。

它適合體育教師、健身教練、醫療保健提供者、健康計劃和學校。自定義措辭、添加品牌、將表單嵌入網站或共享鏈接;回應可以匯出或與其他工具整合以追蹤進度。在行動裝置上收集回應、將結果匯出到電子表格,或連接 100 多個整合以自動化工作流程和跟進以獲得更好的結果。

點擊“使用此模板”立即定制並啟動您的健康習慣問卷。

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