A quick and easy nutrition questionnaire that ranks how healthy your diet is. Designed by an accredited practising dietitian.

1. How many serves of fruit do you usually eat per day? (A fruit serving is equal to 1 cup eg. 1 apple, 1 orange, 10 grapes)

• 2 or more  (4 points)
• One per day  (2 points)
• Zero  (0 points)

Fruit list: _______________  _______________  _______________  _______________  _______________

2. How many serves of veggies do you usually eat per day? (Serving = 1/2 cup cooked veg or 1 cup of salads)

• One or less  (0 points)
• 2 -3  (2 points)
• 4-5  (4 points)
• more than 5  (5 points)

3. How many combined serves of milk, yoghurt and cheese do you usually have per day? (1 serve = 250ml milk, 200g yoghurt, 40g cheese)

• 2 or more  (4 points)
• One   (2 points)
• Less than one  (0 points)

Type of Milk:

Type of Cheese:

Type of yoghurt:

4. Are most of your breads, cereal and rice products wholegrain based?

• Yes  (4 points)
• No  (0 points)

Type of breakfast cereal: ____________________________________

Type of bread: ____________________________________

Type of rice: ____________________________________

Type of pasta: ____________________________________

5. How often do you eat breakfast?

• Everyday  (5 points)
• Most days  (3 points)
• No often  (0 points)

6. Do you usually include healthy (low sugar) mid meal snacks?

• Yes, most days  (4 points)
• Only occasionally  (2 points)
• Very rarely  (0 points)

List of snacks: _________________________________________________________________________

7. How many servings of fish do you usually eat per week? (one serve is approximately 75-100g cooked)

• Zero  (0 points)
• One  (2 points)
• 2 or more  (4 points)

8. How many times do you have take-away per week?

• 1 or less  (4 points)
• 2-3   (0 points)
• 3 or more  (minus 2 points)

Favorite take-away: ___________________  ____________________  _____________________

9. How would you rate your level of fullness after your main meal?

• Lightly filled/content     (4 points)
• Moderately full but comfortable  (2 points)
• Very full/uncomfortable  (0 points)
• Stuffed full/feeling sick  (minus 2 points)

10. How would you rate your average speed of eating?

• Fast  (0 points)
• Medium  (2 points)
• Slow  (4 points)

11. How often do you consume confectionary type foods?

• Less than 3 times per week  (5 points)
• 3-5 times per week   (3 points)
• Once per day   (2 points)
• More often  (zero points)

List of favorite treats:

12. How many glasses of water do you usually drink per day? (One glass is equal to 250ml)

• 2-3 or more  (2 points)
• 4-5  (4 points)
• 6 or more  (5 points)

13. How many glasses of soft drinks and sweetened beverages do you usually drink?

• Once a week or less  (4 points)
• 2-3 times per week  (2 points)
• More often  (0 points)

14. How many times per week do you consume alcohol in excess of the recommended 2 standard drinks?

• Never  (4 points)
• Once    (0 points)
• More than once  (minus 2 points)

 

Your score: _____ /60

 

Where do you rank?

55+ Perfect diet

50-54 Very Healthy

40-49 Not bad

30-39 Somewhat nutritious

20-29 Some change needed

Less than 20 Complete overhaul!

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