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  2. 2013
  3. March
  4. E
  5. Eating Habits
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Exit Survey
 
 
Are there any meals that you had as a child that you still prepare today?
 
Yes
 
No
 
 
 
In which category would you describe your lifestyle?
 
Retired
 
Semi-retired
 
Employed
 
Volunteer
 
Other
 
 
 
 
How often do you buy take-away?
 
Never
 
Sometimes
 
Often
 
Daily
 
 
 
How often do you eat out?
 
Never
 
Sometimes
 
Often
 
Daily
 
 
 
How old are you?
 
60-65
 
66-70
 
70-75
 
76+
 
 
 
Do you eat the recommended daily intake of five vegetables?
 
Never
 
Sometimes
 
Often
 
Daily
 
 
 
Do you have any dietary restrictions due to chronic illness/diseases such as hypertension, diabetes, etc. ?
 
Yes
 
No
 
 
 
If 'Yes', list some examples:
   
 
 
 
Do you have any physical ailments that can affect your ability to eat?
 
Yes
 
No
 
 
 
Tick the types of foods you prefer:
 
Chinese
 
Japanese
 
Thai
 
Italian
 
Indian
 
Mexican
 
Other