Healthy Eating Habits Survey

Please fill out this survey to help us understand your eating habits. Your input will help in gathering information to promote healthier lifestyles. All answers will remain confidential.

Name:
Home City/Town:
State:
How many meals do you eat per day?	2 meals 3 meals 4 meals
How often do you exercise?	Daily Weekly Rarely
Dietary Restrictions:	Gluten-Free Vegetarian Vegan None
What types of cuisine do you prefer? (Select all that apply):	Italian Chinese Mexican Indian Others
Additional Comments: