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Food Survey

 

What is your gender?
What is your age?
Where do you currently live?
Please estimate your annual household income ( US dollars).
Which of the following best describes your occupation?
What is your marital status?
Which best describes your overall eating habits
Does your diet include red meat?
Are you familiar with Mad Cow disease?
Are you concerned about Mad Cow disease spreading?
Are you familiar with genetic experimenting with foods?
Are you concerned about the negative effects from genetically altering foods?
Do you watch what you eat on a regular basis?
 

For each of the following statements, use the criteria listed that best describes your feelings.

Strongly Agree Agree Unsure Disagree Strongly Disagree
I am concerned additives and other changes to how food is prepared today
I will not adjust my current diet no matter what anyone says
Vegetarian eating is the most healthy way to eat
My favorite food is healthy
My diet is low fat
I have tried to change my diet unsucessfully several times
I prepare most of the foods I eat
I need to lose weight
I research foods and nutrition for everything I eat
I eat a lot of desserts
How food is prepared is important to me
There is nothing like a good burger or steak
Which foods do you eat most often (choose your top 3 food items)
Red Meat
Poultry
Vegetables
Fast Food
Potatoes
Seafood
Pasta
Rice
Beans
Low fat
Low sodium
Sweets
Breads
Choice

Thank you for taking the time to complete this survey. Select Submit Survey now to send your responses to us.


This questionnaire was created by Perseus SurveySolutions for the Web.