Survey Form
This is a comprehensive survey about eating habits and lifestyle.
Personal Information
Name:
Email:
Age:
Gender:
Select
Male
Female
Other
Country of Residence:
Eating Habits
Preferred Cuisine:
Select
Indian
American
French
Chinese
Italian
Mexican
Japanese
Other
How many meals do you eat per day?
Once
Twice
More than twice
Are you a vegetarian?
Yes
No
Do you have any food allergies or dietary restrictions? If yes, please specify:
Food Preferences
Favorite Food:
Least Favorite Food:
Favorite Snacks:
Lifestyle and Health
How often do you exercise per week?
Select
Rarely or Never
1-2 times per week
3-5 times per week
Daily
Average hours of sleep per night:
What are your health goals or aspirations?
Feedback
Any suggestions for improvement?
How would you rate your overall eating habits on a scale of 1 to 10?
Additional Options
I agree to the
Terms and Conditions
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