Diet Questionnaire

Here’s a list of common questions we’re likely to ask you about your diet.

How many times a day do you drink:

• Coffee or tea with sugar between meals?

• Pop, Kool-aid, lemonade, fruit juice, rice milk or iced tea with sugar between meals?

How many times a day do you:

• Chew regular gum (Not sugarless)?

• Eat mints, lozenges, candies, candy bars?

• Eat sweetened baked goods (Donuts, cookies, pastries) between meals?

Do you have a habit of sipping a sweetened drink (Coffee, cola) or eating a sweet snack over an extended period of time, 45 minutes or more?