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Food & Lifestyle Quiz
Step
1
of
13
7%
Your Information
Name
*
First
Last
Email
*
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Phone
*
1. Drinks (typical day)
a. Water
*
<2 cups
3-4 cups
1.25L
1.5L
>2L
b. Soft Drink
*
none
<2 cups
3-4 cups
1.25L
>1.5L
c. Cordial
*
none
<2 cups
3-4 cups
1.25L
>1.5L
d. Coffee
*
none
<2 cups
3-4 cups
5-6 cups
>7 cups
e. Tea
*
none
<2 cups
3-4 cups
5-6 cups
>7 cups
f. Alcohol
*
none
1x /wk
2x /wk
3x /wk
4x /wk
5x /wk
6x /wk
7x /wk
Type(s) & Amount(s)
g. Sports Drinks
*
none
1x /wk
2x /wk
3x /wk
4x /wk
5x /wk
6x /wk
7x /wk
Type(s) & Amount(s)
h. Supplements
*
none
1x /wk
2x /wk
3x /wk
4x /wk
5x /wk
6x /wk
7x /wk
Type(s) & Amount(s)
2. Breads & Cereals (avg. week)
a. Sliced Bread
*
none
1x /wk
2x /wk
3x /wk
4x /wk
5x /wk
6x /wk
7x /wk
Type(s) & Amount(s)
b. Cereal
*
none
1x /wk
2x /wk
3x /wk
4x /wk
5x /wk
6x /wk
7x /wk
Type(s) & Amount(s)
c. Pasta/Noodles
*
none
1x /wk
2x /wk
3x /wk
4x /wk
5x /wk
6x /wk
7x /wk
Type(s) & Amount(s)
d. Rice
*
none
1x /wk
2x /wk
3x /wk
4x /wk
5x /wk
6x /wk
7x /wk
Type(s) & Amount(s)
3. Fruit (avg. week)
1 piece = 1 banana, 2 apricots, 2 kiwi, 2 small mandarins, 1 orange, 1 apple/pear, etc...
a. Times per week
*
none
1x /wk
2x /wk
3x /wk
4x /wk
5x /wk
6x /wk
7x /wk
b. Pieces per day
*
none
1
2
3
4
5+
4. Vegetables (avg. week)
a. Times per week
*
none
1x /wk
2x /wk
3x /wk
4x /wk
5x /wk
6x /wk
7x /wk
b. Amount of raw salad vegetables
*
none
1/2 cup
1 cup
1 1/2 cups
2 cups
2 1/2 cups
3 or more cups
c. Amount of cooked vegetables
*
none
1/2 cup
1 cup
1 1/2 cups
2 cups
2 1/2 cups
3 or more cups
5. Legumes (avg. week)
Baked beans, chickpeas, lentils, lentil burgers, etc...
a. Times per week
*
none
1x /wk
2x /wk
3x /wk
4x /wk
5x /wk
6x /wk
7x /wk
b. Amount
*
1/4 cup
1/2 cup
1 cup
1 1/2 cups
2 or more cups
6. Eggs (avg. week)
Not included in cakes, quiches, etc...
a. Amount
*
none
2 or less
3
4
5
6 or more
7. Dairy or Alternatives (avg. week)
If consuming alternatives to dairy, please briefly outline below:
a. Milk
*
none
1x /wk
2x /wk
3x /wk
4x /wk
5x /wk
6x /wk
7x /wk
Amount
*
< 1/4 cup
1/4 cup
1/2 cup
1 cup
1 1/2 cups
2 or more cups
b. Cheese
*
none
1x /wk
2x /wk
3x /wk
4x /wk
5x /wk
6x /wk
7x /wk
Amount
*
15g (1 slice)
30g (2 slices)
45g (3 slices)
60g (4 slices) or more
c. Yoghurt
*
none
1x /wk
2x /wk
3x /wk
4x /wk
5x /wk
6x /wk
7x /wk
Amount
*
< 1/4 cup
1/4 cup
1/2 cup
1 cup
1 1/2 cups
2 or more cups
8. Red Meat or Alternatives (avg. week)
Mince, steak, chops, vegetarian alternatives, etc...
a. Times per week
*
none
1x /wk
2x /wk
3x /wk
4x /wk
5x /wk
6x /wk
7x /wk
Amount
*
< 80 grams
100 grams
120 grams
140 grams
160 grams
180 or more grams
If consuming vegetarian alternatives to red meat, please briefly outline below:
9. Chicken or Alternatives (avg. week)
BBQ, fillets, thigh, vegetarian alternatives, etc...
a. Times per week
*
none
1x /wk
2x /wk
3x /wk
4x /wk
5x /wk
6x /wk
7x /wk
Amount
*
< 80 grams
100 grams
120 grams
140 grams
160 grams
180 or more grams
If consuming vegetarian alternatives to chicken, please briefly outline below:
10. Fish or Alternatives (avg. week)
Crumbed, baked, grilled, fried, fingers, squid, shellfish, vegetarian alternatives, etc...
a. Times per week
*
none
1x /wk
2x /wk
3x /wk
4x /wk
5x /wk
6x /wk
7x /wk
Amount
*
< 80 grams
100 grams
120 grams
140 grams
160 grams
180 or more grams
If consuming vegetarian alternatives to fish, please briefly outline below:
11. Snacks (avg. week)
a. Ice cream
*
none
1x /wk
2x /wk
3x /wk
4x /wk
5x /wk
6x /wk
7x /wk
Amount
*
1 scoop
2 scoops
3 scoops
4 or more scoops
b. Nuts
*
none
1x /wk
2x /wk
3x /wk
4x /wk
5x /wk
6x /wk
7x /wk
Amount
*
< 1/4 cup
1/4 cup
1/2 cup
1 cup
1 1/2 cups
2 or more cups
c. Chips
*
none
1x /wk
2x /wk
3x /wk
4x /wk
5x /wk
6x /wk
7x /wk
Amount
*
small packet
medium packet
large packet
d. Biscuits
*
none
1x /wk
2x /wk
3x /wk
4x /wk
5x /wk
6x /wk
7x /wk
Type(s) & Amount(s)
e. Cake
*
none
1x /wk
2x /wk
3x /wk
4x /wk
5x /wk
6x /wk
7x /wk
Type(s) & Amount(s)
f. Chocolate
*
none
1x /wk
2x /wk
3x /wk
4x /wk
5x /wk
6x /wk
7x /wk
Amount
*
4 or less squares
~50g bar
~80g bar
1/2 family block or more
g. Lollies
*
none
1x /wk
2x /wk
3x /wk
4x /wk
5x /wk
6x /wk
7x /wk
Amount
*
1/4 or less cup
1/2 cup
1 cup
1 1/2 or more cups
12. Exercise (avg. week)
a. Times per week
*
none
1x /wk
2x /wk
3x /wk
4x /wk
5x /wk
6x /wk
7x /wk
Type(s) & Amount(s)
Name
This field is for validation purposes and should be left unchanged.
