Health & Diet
1. Name : Age:
Weight: Height:
2.Do you perceive yourself?
(a) Normal weight
(b) Under weight
(c) Over weight
3. Do you smoke?
(a) Yes
(b) No
(c) occasionally
4. Do you drink?
(a) Yes
(b)No
(c)Occasionally
5. what do you perceive yourself?
(a) Sedentary
(b) Moderately active
(c)Very active
6.do you play any sport?
(a) Yes
(b) No
(c) Sometimes
7. what kind of diet are you following?
(a) For weight gain
(b) For muscle building
(c) For weight loss
(d) Normal diet
8. Are you :
(a)Vegetarian
(b) Non-vegetarian
(c) Eggitarian
9. Do you miss any meal out of the following?
(a) Breakfast
(b) Lunch
(c) Dinner
(d) None of the above
10. How often do you miss a certain meal?
(a) Always
(b) Sometimes
(c) Never
11.How often do you get food delivered at home?
(a) Daily
(b) Frequently
(c) Occasionally
(d) Never
12. what kind of food do you normally get delivered?
(a) Fast food
(b) Chinese
(c) Indian
(d) Continental
13.what beverage do you usually consume?
(a) Soft drink
(b) Tea/coffee
(c) Juice
(d) Nothing
14.what do you usually take in Tiffin/lunch?
(a) Sandwich
(b) Roti & sabzi
(c) Wrap
(d) Buy from canteen
(e) Nothing
15.what do your parents complain about your eating habits?
(a)Overeat
(b)Eat less than you should
(c)Don’t complain
16. During a holiday , meals are:
(a)Elaborate, heavy meals
(b)Eating out ,restaurants
(c)Home delivered
(d)None of the above
thank you for your time 
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