Healthy Habits Questionnaire

Explore the full daily routine: breakfast, chewing pace, timing of the last meal, drinks, sweeteners, late-night snacking and exercise. Health coaches and corporate wellbeing programmes use it to propose small, sustainable changes. It ends by asking which goal the person wants to reach.

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What do you usually have for breakfast?

Do you feel hungry or tired before lunch?

Yes Sometimes No

What do you normally have for lunch?

How long does each meal last on average?

Under 5 minutes 5 to 10 minutes 10 to 20 minutes 20 to 30 minutes Over 30 minutes

How many times do you chew before swallowing?

Fewer than 5 times 5 to 10 times 10 to 20 times 20 to 30 times More than 30 times

What time do you have the last meal of the day?

Before 6 pm Between 6 and 7 pm Between 7 and 8 pm Between 8 and 9 pm After 9 pm

At what point do you stop eating?

When I feel satisfied When the plate is empty When I am very full When time runs out

When you want a drink other than water, what do you choose?

What do you use to sweeten your drinks or food?

How often do you snack after dinner?

How often do you exercise?

Never One or two times a week Three or four times a week Five or six times a week Every day

Would you say you are under, over or at the right weight?

Under weight Just right Over weight

Do you have weight or health goals?

Yes No Not sure

Which goals do you want to reach?

Lose weight Gain muscle Have more energy Digest better Sleep better Manage a condition

How would you describe your gender?

Female Male Non-binary Prefer not to say

Would you like to know how small changes could help you reach your goals?

Yes Maybe No

Full name

Nombre

Apellido

Phone number

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