Measures dietary patterns, nutrition goals, purchasing behavior, and barriers to healthy eating. Use to segment customers, identify unmet needs, and inform food product or service development.
What's Included
AI-Powered Questions
Intelligent follow-up questions based on responses
Automated Analysis
Real-time sentiment and insight detection
Smart Distribution
Target the right audience automatically
Detailed Reports
Comprehensive insights and recommendations
Template Overview
25
Questions
AI-Powered
Smart Analysis
Ready-to-Use
Launch in Minutes
This professionally designed survey template helps you gather valuable insights with intelligent question flow and automated analysis.
Sample Survey Items
Q1
Chat Message
Welcome! This survey asks about your eating habits, nutrition goals, and grocery shopping behaviors. It should take approximately 8–10 minutes to complete.
Your participation is entirely voluntary and you may stop at any time. There are no right or wrong answers—we are interested in your honest opinions. All responses are confidential and will be reported in aggregate only.
Q2
Multiple Choice
Do you currently follow any specific dietary pattern? (Select all that apply.)
No specific pattern
Vegetarian
Vegan
Pescatarian
Keto or low-carb
Low-sugar
Gluten-free
Dairy-free
Halal
Kosher
Other (please specify)
Q3
Opinion Scale
In the last 30 days, how consistently did you follow your dietary pattern?
Range: 1 – 7
Min: Not at all consistentlyMid: NeutralMax: Very consistently
Q4
Dropdown
In the last 7 days, approximately how many meals did you cook at home?
0
1–3
4–7
8–14
15–21
More than 21
Q5
Opinion Scale
In the last 7 days, how often did you snack between meals?
Range: 1 – 7
Min: NeverMid: NeutralMax: Very often
Q6
Multiple Choice
Where do you buy groceries most often? (Select up to 2.)
In-store supermarket
Online-only grocer
Retailer pickup or delivery
Meal kit subscription
Restaurant or food delivery apps
Farmers market or specialty store
Other (please specify)
Q7
Dropdown
In the last 30 days, how many times did you order food or groceries online?
None
1–2 times
3–4 times
5–8 times
9 or more times
Q8
Multiple Choice
What are your top eating goals for the next 3 months? (Select up to 3.)
Eat more fruits and vegetables
Reduce added sugar
Manage weight
Build muscle or strength
Save time on meals
Spend less on food
Improve daily energy
Manage a health condition
Be more environmentally sustainable
Try new foods or cuisines
Other (please specify)
Q9
Multiple Choice
Which of the following approaches would you consider trying to reach your eating goals? (Select all that apply.)
Portion control
Higher-protein meals
Calorie or macro tracking
Meal kits with nutrition targets
Ready-to-eat healthy options
Cutting added sugar
Intermittent fasting
Working with a nutritionist or coach
Meal planning or prepping
Other (please specify)
Q10
Opinion Scale
How confident are you that you can maintain your eating changes over the next 30 days?
Range: 1 – 7
Min: Not at all confidentMid: NeutralMax: Extremely confident
Q11
Multiple Choice
What gets in the way of eating the way you want? (Select all that apply.)
Food cost
Time to cook
Taste preferences
Lack of meal planning
Limited healthy options nearby
Family or household preferences
Cravings
Stress or mood
Portion control
Delivery fees or order minimums
Short shelf-life of fresh items
Confusing labels or nutrition info
Other (please specify)
Q12
Dropdown
Of the barriers you selected, which is the single biggest obstacle for you right now?
Food cost
Time to cook
Taste preferences
Lack of meal planning
Limited healthy options nearby
Family or household preferences
Cravings
Stress or mood
Portion control
Delivery fees or order minimums
Short shelf-life of fresh items
Confusing labels or nutrition info
Other
Q13
Opinion Scale
How useful would a personalized meal-planning tool be in helping you eat the way you want?
Range: 1 – 7
Min: Not at all usefulMid: NeutralMax: Extremely useful
Q14
Opinion Scale
How useful would simplified nutrition labels or scoring be in helping you eat the way you want?
Range: 1 – 7
Min: Not at all usefulMid: NeutralMax: Extremely useful
Q15
Opinion Scale
How useful would budget-friendly healthy recipe suggestions be in helping you eat the way you want?
Range: 1 – 7
Min: Not at all usefulMid: NeutralMax: Extremely useful
Q16
Opinion Scale
How likely would you be to try an online grocery service that offered features aligned with your eating goals?
Range: 1 – 7
Min: Very unlikelyMid: NeutralMax: Very likely
Q17
AI Interview
We'd like to learn more about your eating goals and the challenges you face. An AI moderator will ask you a couple of brief follow-up questions.
AI InterviewLength: 2Personality: [Object Object]Mode: Fast
Reference questions: 5
Q18
Long Text
Based on your responses in this survey, is there anything else you'd like to share about your eating habits, goals, or challenges?
Max chars
Q19
Dropdown
What is your age?
18–24
25–34
35–44
45–54
55–64
65+
Prefer not to say
Q20
Multiple Choice
How do you describe your gender?
Woman
Man
Non-binary
Prefer to self-describe
Prefer not to say
Q21
Dropdown
Where do you currently live?
United States
Canada
United Kingdom
European Union
Australia / New Zealand
India
Southeast Asia
Middle East / North Africa
Sub-Saharan Africa
Latin America
Other
Q22
Dropdown
What is the highest level of education you have completed?
High school or less
Some college / associate degree
Bachelor's degree
Graduate or professional degree
Other
Prefer not to say
Q23
Dropdown
What is your current employment status?
Full-time
Part-time
Self-employed
Student
Homemaker / caregiver
Retired
Unemployed
Prefer not to say
Q24
Dropdown
What is your approximate annual household income?
Under $25,000
$25,000–$49,999
$50,000–$74,999
$75,000–$99,999
$100,000–$149,999
$150,000 or more
Prefer not to say
Q25
Chat Message
Thank you for completing this survey! Your responses are valuable and will help improve products and services related to nutrition and healthy eating.
Frequently Asked Questions
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QuestionPunk is an AI-powered survey and research platform that turns traditional surveys into adaptive conversations. Describe your research goal and get a complete survey draft, conduct AI-moderated interviews with dynamic follow-ups, detect low-quality responses, and produce insights automatically. It's fast, flexible, and scalable across qualitative and quantitative research.
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How do AI interviews work?
AI interviews conduct adaptive conversations with respondents. The AI asks follow-up questions based on what the respondent says, probing for clarity and depth. You control the personality, tone, model (Haiku, Sonnet, or Opus), and question mode (fixed count, AI decides when to stop, or time-based).
Can I test my survey before launching?
Yes. Use synthetic testing to create AI personas and run them through your survey. This helps catch issues with question flow, logic, and wording before real respondents see it.
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