Mediterranean Diet Adherence Form

Name

Date

How often do you consume the following?

Olive oil as main added fat

Yes No
Vegetables (≥2 servings/day)

Yes No
Fruits (≥3 servings/day)

Yes No
Red/processed meats (<1 serving/day)

Yes No
Wine (moderate intake)

Yes No N/A
Legumes (≥3 servings/week)

Yes No
Fish/seafood (≥3 servings/week)

Yes No
Nuts (≥3 servings/week)

Yes No
Commercial sweets/pastries (<3/week)

Yes No

Comments or Notes