DIET & EXERCISE SURVEY TEMPLATE

To help people achieve their fitness and diet goals, send this survey. Our expert-certified diet and exercise template gives you insight into the exercise and eating habits of people. The information you receive can help you plan successful programs to help people live healthier lives. You’ll get a better understanding of how much they exercise and the types of foods they eat.

DIET & EXERCISE SURVEY

1. How physically healthy are you?

Not at all likely Extremely likely
0 1 2 3 4 5 6 7 8 9

2.   Do you take nutritional supplements?

–  Yes
–  No

 

3. How important is exercise to you?

Not at all likely Extremely likely
0 1 2 3 4 5 6 7 8 9

4. What do you most often do for exercise?

– Lift weights

– Walk

– Run

– Hike

– Swim

– Aerobics

– Play a team sport

– Other ________

5. In a typical day, how much of your meals or snacks include carbohydrates?

________ %

6. In a typical day, how much of your meals or snacks include proteins?

________ %

7. In a typical day, how much of your meals or snacks include vegetables?

________ %

8. In a typical day, how much of your meals or snacks include fruits?

________ %

9. In a typical day, how many microwavable or ready-made meals do you eat?

________ %

10. How do you describe a healthy person?

[Answer box]