Eating Habits Questionnaire

Elena Biedert

I’d like to understand more about your current eating and nutrition habits. It’s very important that you answer the questions as honestly as you can. There are no right or wrong answers. I’m not judging you.

All we are doing here is just gathering data and information to help you move towards your goals. The more you can tell me about your current habits, experiences, and mindset around eating, the more I can help.

All the information shared throughout this form is confidential and will be used by me only to provide you the best results. For more information please see our Data Protection Policy.

Right now, on a scale of 1-10, how consistent would you say you are with your eating habits?

Do you have any known / diagnosed food allergies or intolerances?

Do you have any suspected or possible food allergies or intolerances?

How often do you have a bowel movement?

Do you have any digestive system complaints right now?

On a scale of 1-10, how would you describe your normal appetite / hunger?

Do you feel like you have trouble controlling your appetite / hunger?

Do you normally struggle with food cravings?

Have you ever noticed any connection between your emotions and your eating habits?

Have you ever noticed any connection between stress and your eating habits?

How often do you think about food and eating (or avoid eating)?

How often do you eat to the point of being full or stuffed?

If you feel you've eaten too much, what do you do afterwards? Check all that apply.

How often do you skip meals or purposely go a long time without eating?

How often do you normally make meals at home?

How often do you normally eat meals in restaurants / cafeterias?

How often do you shop for food?

On a scale of 1-10, how would you rank your food preparation and cooking skills right now?

Do you like cooking?

13 + 14 =

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