We’d like you to fill in the following questionnaire in order to collect some information about you and your

eating habits.

Class: ___________ Male ___ Female ___ Age: __________ 1. Do you have breakfast before going to school? ¨ Always ¨ Sometimes ¨ Never 2. What do you normally have for breakfast? ¨ Bread ¨ Cereals ¨ ¨ ¨ ¨ Milk Coffee Juice Yogurt

¨ Cookies ¨ Fruit ¨ Something else: ____________ 3. Do you usually have a snack in the morning/ in the afternoon? ¨ Always ¨ Sometimes ¨ Never 4. How often do you eat salad or vegetables with lunch or dinner? ¨ Always ¨ Frequently ¨ Sometimes ¨ Rarely ¨ Never 5. Do you usually eat soup? ¨ Everyday ¨ 2 or 3 times a week ¨ Rarely ¨ Never 6. How many times a week do you eat fish? ¨ Everyday ¨ 2 or 3 times a week ¨ Rarely ¨ Never 7. How often do you eat fruit? ¨ Everyday ¨ 2 or 3 times a week ¨ Rarely

Do you usually have a dessert with your lunch or dinner? ¨ Always ¨ Frequently ¨ Sometimes ¨ Rarely ¨ Never 9. What do you drink at meals? ¨ Water ¨ ¨ ¨ ¨ Wine Juice Tea Something else: _________ 11. How frequently do you eat at fast food restaurants? ¨ Never ¨ 2 or 3 times a week ¨ Almost everyday ¨ Everyday 12. Do you use food supplements to complete your diet? ¨ Yes ¨ No 13. What do you usually have for dessert? ¨ ¨ ¨ ¨ Fruit Yogurt Cake Coffee ¨ Something else: ________ 10. Do you think you have healthy eating habits? ¨ Yes ¨ No Thank you for your cooperation and don’t forget to have a healthy diet! .¨ Never 8.

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