General Informations
Your Name
Your age Gender Male Female
Where you come from?
Your E-Mail Address:
Who purchases food at your home?
Who prepares?
What kind of meat do you usually buy? Regular cuts Lean cuts
How do you usually prepare meat? Fry Bake Broil Stew/Slow cook
How many snacks do you eat each day? 1 2 3 4 More
How many meals? 1 2 3 4 5
How many times each week do you eat away from home? 1 2 3 4 More
What restaurant do you go to most often?
Do you take any vitamin or mineral tablets? Yes No
If yes, please list the kinds and amounts:
Do you eat any special foods for health or personal reasons? Yes No
At the table, do you add salt to your food? Yes No
Date Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Tank you for cooperation
Last updated 02/08/2003
Copyright ã 1999-2000-2001-2002-2003 by Eugenia Tesoro - All rights reserved
