Nutrition Study Dietary Screening Form
Participant Information
Full Name
Age
Date
Gender
Male
Female
Other
Dietary Habits
How many meals do you eat per day?
How many snacks do you have per day?
Do you follow any specific diet (e.g., vegetarian, vegan, gluten-free)?
Do you have any food allergies or intolerances?
Daily Intake Frequency
How often do you consume fruits?
Never
Rarely
Sometimes
Often
Daily
How often do you consume vegetables?
Never
Rarely
Sometimes
Often
Daily
How often do you consume whole grains?
Never
Rarely
Sometimes
Often
Daily
How often do you consume sugar-sweetened beverages or foods?
Never
Rarely
Sometimes
Often
Daily
Additional Information
Do you take any dietary supplements or vitamins?
Comments or Remarks