Name ______
Food Survey
Answer each of the following questions in the space provided. You may need to talk with your family to answer some of the questions.
1. What foods did you eat as a child?
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a) What foods did your parents make you eat?
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b) What foods were you not allowed to eat?
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c) Which of these foods do you still enjoy today?
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d) What new foods do you enjoy now that you didn’t eat when you were little?
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2. What are your favorite foods?
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3. What are your least favorite foods?
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4. What foods have you not eaten but you would like to try?
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5. What foods would you never like to try?
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6. Describe the types of situations where you eat? ( ie. What time of day? Who do you eat with? Where are you eating?)
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7. Who prepares the food you eat?
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8. Who shops for the groceries in your home?
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9. What foods are you able to prepare or cook?
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10. How often do you prepare or cook food for yourself or others?
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11. Complete the chart by recording the foods you eat or associate with the following events:
Event or Situation / Foods I eat or associate with this occasion:when I feel sick
when I feel happy
when I feel nervous or anxious
when I feel depressed or lonely
when I am with family
when I am with my closest friends
when I am at school
when I am in a hurry
when I feel like cooking
when I am at a party
when I am at a wedding reception
when I am at a family birthday party
when I go out for dinner with my friends
when I go out on a date
at Thanksgiving
at Christmas
at Easter
when I am on a picnic
when I go to the movies
when I go camping
other situation ______
other situation ______
other situation ______
other situation______