Password: * Initials: * Height (Ft./Inches): Weight (lbs): Age: Gender: Male Female In a typical or average day, how often do you drink a sugar-sweetened beverage or eat a sweet such as ice cream or cake? Never/less than 1 (once) Once 2 to 3 times 4 to 5 times More than 5 times In a typical or average day, how many servings of whole fruit (e.g., an average size apple or banana or cup of berries) do you eat? Never/less than 1 1 2 to 3 3 to 4 5 or more In a typical or average day, how many servings do you consume of full-fat milk, yoghurt, or eat cheese? Never/less than 1 Once 2 3 4 or more In a typical or average day, how many servings of non-starchy vegetables do you eat (e.g., green or brightly colored vegetables, not potatoes), including as part of mixed dishes? Never/less than 1 1 2 to 3 3 to 4 5 or more In a typical or average day, how many servings of meat do you eat? Never Half a serving 1 2 3 or more Are you a strict vegetarian who never eats fish? Please select Yes or No: Yes No In a typical or average day, how many servings of fish or seafood do you eat (a serving is about 4 ounces), including as part of mixed dishes? Never Half a serving 1 2 3 or more In a typical or average day, how many servings of refined wheat or other grain products (e.g. white bread, or white rice) do you eat? Never Half a serving 1 2 3 or more In a typical or average day, how many servings of whole wheat or other whole grain products (e.g. wholegrain bread, short-grain brown rice, bulgur) do you eat? Never Half a serving 1 2 3 or more In a typical or average day, how many servings of solid fat (e.g., a pat or teaspoon butter, coconut oil or a processed food such as a flour tortilla or a deep-fried food, such as fried chicken) do you eat? Never Half a serving 1 2 3 or more Please enable JavaScript for this form to work.
