The eating or diet questionnaire is designed to increase your knowledge and awareness of your
overall diet, and to highlight potential areas of concern.
Here are 6 main questions on a diet questionnaire.
1. Do you drink enough fluids so that
your urine is a pale yellow color?
2. Do you try special or fad diets?
3. Do you add salt to foods during cooking
at the table?
4. Do you minimize your intake of sweets,
especially candy and soft drinks, and
avoid adding sugar to foods?
5. Is your diet well-balanced (including
vegetables, fruits, breads, cereals, dairy
products, and adequate sources of
6. Do you limit your intake of saturated
fats (butter, cheese, cream, fatty meats)?
7. Do you limit your intake of cholesterol
(eggs, liver, meats)?
8. Do you eat fish and poultry more often
than red meats?
9. Do you eat high-fiber foods (vegetables,
fruits, whole grains) several times at day?
There are 3 additional questions on this form.
Click the Link below to download an diet questionnaire.