Horizons Food Survey
Name: 


  1. How often do you eat at a fast-food restaurant (McDonalds, Burger King, Duchess, Subway, etc) or a take-out corner store?
    Often (every DAY or almost every DAY)
    Sometimes (2-4 times per WEEK)
    Rarely (1-3 times per MONTH)
    Never


  1. How often do you eat at a sit-down non-fast-food restaurant?
    Often (every DAY or almost every DAY)
    Sometimes (2-4 times per WEEK)
    Rarely (1-3 times per MONTH)
    Never


  1. How often do you eat a frozen packaged meal from the grocery store?
    Often (every DAY or almost every DAY)
    Sometimes (2-4 times per WEEK)
    Rarely (1-3 times per MONTH)
    Never


  1. How often do you eat fruit (berries, apples, bananas, oranges, etc.)?
    Often (every DAY or almost every DAY)
    Sometimes (2-4 times per WEEK)
    Rarely (1-3 times per MONTH)
    Never


  1. How often do you eat RAW (uncooked) vegetables such as carrots, celery, peppers, cucumbers, etc.
    Often (every DAY or almost every DAY)
    Sometimes (2-4 times per WEEK)
    Rarely (1-3 times per MONTH)
    Never


  1. How often do you eat cooked vegetables?
    Often (every DAY or almost every DAY)
    Sometimes (2-4 times per WEEK)
    Rarely (1-3 times per MONTH)
    Never


  1. How often do you eat hamburger meat or steak?
    Often (every DAY or almost every DAY)
    Sometimes (2-4 times per WEEK)
    Rarely (1-3 times per MONTH)
    Never


  1. How often do you drink a soda or a fruit punch/drink with added sugar?
    Often (every DAY or almost every DAY)
    Sometimes (2-4 times per WEEK)
    Rarely (1-3 times per MONTH)
    Never


  1. How often do you eat dessert or other sugary treat?
    Often (every DAY or almost every DAY)
    Sometimes (2-4 times per WEEK)
    Rarely (1-3 times per MONTH)
    Never


  1. How often do you drink fruit juice (100% juice with no added sugar)?

    Often (every DAY or almost every DAY)
    Sometimes (2-4 times per WEEK)
    Rarely (1-3 times per MONTH)
    Never


  1. How often do you eat nuts (almonds, walnuts, pecans, etc.) or seeds (sunflower, pumpkin)?
    Often (every DAY or almost every DAY)
    Sometimes (2-4 times per WEEK)
    Rarely (1-3 times per MONTH)
    Never


  1. How often do you eat fried food (chicken fingers, French fries, doughnuts, potato chips, etc)?
    Often (every DAY or almost every DAY)
    Sometimes (2-4 times per WEEK)
    Rarely (1-3 times per MONTH)
    Never


  1. How often do you eat a salad at lunch or dinner?
    Often (every DAY or almost every DAY)
    Sometimes (3-4 times per WEEK)
    Rarely (1-3 times per MONTH)
    Never


  1. How often do you eat brown rice, whole wheat bread or whole wheat pasta?
    Often (every DAY or almost every DAY)
    Sometimes (3-4 times per WEEK)
    Rarely (1-3 times per MONTH)
    Never


  1. How often do you eat white rice, white bread or white pasta?
    Often (every DAY or almost every DAY)
    Sometimes (3-4 times per WEEK)
    Rarely (1-3 times per MONTH)
    Never





Michael Gomola