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Please select the option which best describes your average daily consumption for the following:

Whole grains aren't my friends and I eat 0 - 1 serving.
I try to eat 2 or 3 servings.
1 whole grain item per meal is my motto, only the good carbs for me! (3 or more servings).
I love the carbs, but the not whole grain kind.
I only eat a few veggies once in a while, not daily.
Sure, I eat my veggies (about 2 cups a day), but not always dark leafy veggies like Popeye.
I eat so many vegetables (more than 2 cups), greens, purple, orange - bring 'em on.
I'm actually eating fruit right now, that's how much fruit I eat each day (at least 2 pieces or 2 cups).
An apple a day, right? But, I really prefer to drink more fruit juice than eat actual fruit (eat about 1 piece or 1 cup).
I love fruit-flavored candy, does that count? I'll have a piece of real fruit once in a while, but not daily.
I keep it lean, about 6 - 12 ounces of the good stuff (lean meat, chicken without the skin, fish, beans or tofu).
I'm kind of good about keeping it lean, but I eat quite a bit (more than 8 ounces a day) of proteins - and sometimes I've just got to have some fat, or some skin on my protein.
I am a ravenous carnivore and eat as much protein as I can. I tend to eat fatty meats, cold cuts, sausage, and dark meat chicken (with skin).
I don't even know what a protein is, I'm a carb lover!
Rarely or never.
I love the cow - the full cow - only regular or full-fat dairy for me, please.
I'm a moderate dairy-lover, having about 1 or 2 cups of fat free or low-fat (1%) milk, yogurt or cottage cheese.
Yummy dairy! I get about 3 cups or more of fat-free or low-fat (1%) from milk, yogurt or cottage cheese.
I measure what I'm using (approximately 2 ounces or less), and look for olive or canola or vegetable, when possible.
I try to watch my intake, but I'm not really sure how much it is.
I don't pay attention to the type or the amount that I eat, does it really matter?!

Choose the answer that best describes your average weekly consumption for the following:

Nope, seafood is not for me.
I eat seafood once a week, especially oily fish like salmon.
I'm on a "seafood" diet (I see it, I eat it!), but really… I eat it at least twice a week, especially oily fish like salmon.
I skip the fish, but get other sources of omega-3 fatty acids.
Lima, fava, kidney, you name it, I eat it. And about 3 cups a week - at least.
Beans sometimes make an appearance in my foods each week.
I don't think about whether I eat them.

Please select the option which best describes your average consumption for the following:

What is fiber? I never check the labels for fiber and I do not track how much I eat.
I try to eat foods with more fiber each day, some days are more successful!
I love fiber-filled foods and am confident that I eat at least 32 grams of fiber each day.
I limit my salt intake and read food labels carefully.
I try to limit my salt intake and sometimes read food labels for salt and sodium ingredients.
I put salt on almost everything (except ice cream, of course) and don't think about how much salt or sodium I consume.
I don't have a sweet tooth and choose/prepare foods and beverages with little of these ingredients.
Moderation is key. I try to eat foods and beverages with only a little added sugar.
The sweeter the better! I eat and drink a lot of sugary foods and beverages.
I eat a lot of processed foods, like frozen dinners and chips.
Maybe I shouldn't, but I eat a lot of fatty red meat and cream cheese.
I know cholesterol-rich foods like eggs, cheese and dark meat poultry should be eaten in moderation, but I tend to eat them several times a day.
I do a fairly good job of avoiding processed foods. I watch what I eat when it comes to fatty foods and cholesterol-rich dishes.
Yes
No
Daily
Several times a week
When I feel the need
I don't take one
With food
On an empty stomach
I don't take one
Yes
No
None
 
Vitamin B/B Complex
Vitamin D
 
Calcium
Zinc
 
Garlic
Saw Palmetto
 
Fiber
Glucosamine + Chondroitin
 
Probiotics
Lycopene
 
Flax Seed/Oil
Fish Oil/omega-3s
 
Vitamin A
Vitamin C
 
Vitamin E
Vitamin K
 
Magnesium
Echinacea
 
Ginkgo Biloba
Conjugated Linoleic Acid (CLA)
 
Sports nutrition supplements
Whole foods supplements
 
Green Tea
St. Johns Wort
 
Coenzyme Q10
Plant (Phyto) Sterols/Stanols
 
Other
Lutein
 
General health, it can only help
 
Energy
To increase muscle mass
 
To fill in nutrition gaps
Particular condition
 
Weight management
Because I think it's the smart thing to do
 
I don't take supplements
Doctor
 
Family
Friends
 
Dietitian/Nutritionist
Naturopathic doctor
 
Chiropractor
Nurse
 
Nurse practitioner
Pharmacist
 
Nowhere
other
 
TV, Radio, Newspapers, Magazines
Internet
 
Salesperson
The most exercise I get is using my TV's remote control (meaning I don't have an exercise regimen).
I try to exercise 2 - 3 times per week.
I exercise at least 4 - 5 times per week and sometimes more.
I exercise every day and feel icky when I don't.
Who has the time? I sure don't and therefore, don't exercise.
I keep it short and sweet, about 30 minutes.
1 hour, it's when I feel the burn.
Nothing better than a 2-hour long sweaty workout.
I don't like to sweat and therefore, don't exercise.
I enjoy cardiovascular exercise like running, walking, aerobics, dancing, tennis or basketball.
I enjoy recreational activities like golfing, playing softball, fishing or camping.
I enjoy strength-training activities like lifting weights.
I enjoy yoga or Pilates.
I try to work out on a regular basis, but life and work often get in the way.
Why change something that works? I stick to the same routine because it works for me.
I like to change my exercise routine on a regular basis just to keep it interesting.
I change my workout on a regular basis in order to improve my performance.
I do not exercise.
Nothing. I'm like a lump on a log.
I take the stairs instead of the elevator at work.
I increase my walking by parking my car in a spot farthest away.
I walk around the office a lot instead of using e-mail.
I try to stay active around the house and in the yard, especially on weekends.
When I feel something is not right.
Annually for a checkup as a preventative measure.
Never.
when I’m really sick
Yes.
Occasionally.
No way!
0
1-2
3-4
More than 4
O, I'm naturally energized.
I need about 1-2 caffeinated drinks to function.
3-5
More than 5, I like to be caffeinated at all times.
I drink more than 8 glasses of water.
I drink less than 8 glasses of water.
I don't drink much water.
Less than 5
5-6
6-7
7-9
More than 9
Yes
No
Occasionally
Male
Female
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