How many cups of dairy do you consume per day on average? *  select 2 cups 2 ½ cups 3 cups Above these Below the minimum given
1 cup dairy= 1 cup milk, 1 cup calcium-fortified soymilk, 1 cup yogurt, 1.5 oz natural cheese, 2 oz processed cheese, 1 cup frozen yogurt, etc.

How many ounces of grain do you consume per day on average? *  select 3 ounces 4 ounces 5 ounces 6 ounces 7 ounces 8 ounces Above these Below the minimum given
1 oz grain= 1 slice of bread, 5 crackers, 1/2 cup oatmeal, 3 cups popcorn, 1/2 cup rice, 1/2 cup pasta, 1 small tortilla, 1/4 bagel, 1 small biscuit, etc.

How many cups of vegetables do you consume per day on average? *  select 1 cup 1 ½ cups 2 cups 2 ½ cups 3 cups Above these Below the minimum given
1 cup vegetables = 1 medium potato, 1 large ear of corn, 2 medium carrots, 1 large sweet potato, 2 cups leafy greens, or 1 cup other chopped veggies

How many cups of fruit do you consume per day on average? *  select 1 cup 1 ½ cups 2 cups Above these Below the minimum given
1 cup fruit = 1 small apple, 1 large banana, 1 medium grapefruit, 1 medium pear, 8 large strawberries, 3 medium plums, or 1 cup of diced fruit

How many ounces of protein do you consume per day on average? *  select 2 ounces 4 ounces 5 ounces 5 ½ ounces 6 ounces 6 ½ ounces Above these Below the minimum given
1 oz protein= 1 egg, 1/2 oz nuts or seeds, 1 Tbsp peanut butter, 1/4 cup beans or peas, 1/4 cup tofu, 2 Tbsp hummus, or 1 oz meat/poultry/fish/shellfish

Do you know your daily caloric need?   * Yes   No  

Do you see a physician for annual checkups?  *Yes   No   

Are you getting an average of at least 30 minutes of exercise per day, 7 days a week?  * Yes  No  

Do you smoke? *Yes   No  

Do you drink alcohol in excess of 1-2 servings per day? * Yes  No  

Do you consume foods with reduced sodium content? * Yes  No  

Do you consume food with minimal added sugar content? * Yes  No  

Do you consume foods low in saturated fats? * Yes  No