Food Frequency Questionnaire

Food Frequency Questionnaire
Name

First Name Last Name
The first step to making realistic and long-term changes to your diet is figuring out where you might be falling short. The Food Frequency Questionnaire is a quick and simple tool you can use to assess what an average week looks like for you.

How often do you eat the foods listed below? Mark the corresponding box for the food category on each day of the week.

**Note this webform must be submitted all at once.
Week of:

- Month - Day Year
Date

	Mon	Tues	Wed	Thurs	Fri	Sat	Sun
Coffee, tea
Sports drinks, bottled juices, sodas
Alcohol
Pasta and cereals
Bread products, baked goods
Vegetable oils, shortening, margarine/spreads, fat substitutes
Pre-packaged foods, processed foods, frozen meals, "fast food"
Desserts, candy
Chips, crackers
Dairy Products including milk, yogurt, cheese, ice cream
Fried foods
Soy Products
Poultry
Red Meat
Fish, shellfish, seafood
Eggs
Beans and legumes
Nuts, seeds, & nut/seed butters
Dark, leafy greens
Colorful vegetables
Raw salad greens and raw vegetables
Fresh, whole fruit
Butter, olive oil, avocado/oil, coconut oil
Filtered water
Restaurant Meals
Meal prepared at home

Lifestyle

	Mon	Tues	Wed	Thurs	Fri	Sat	Sun
Exercise today?
7-9 hours of sleep?
Met daily water baseline? Body weight (lbs.) / 2 = Number of ounces of water daily