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GM Diversity Assessment
Client Assessment Form
Basic Info
1. How many portions of vegetables did you typically eat each day?
(1 portion = 1/2 cup or 125g cooked vegetables, or 1 cup raw vegetables)
Select one...
0 portions (0 points)
1-2 portions (1 point)
3-4 portions (2 points)
5-6 portions (3 points)
7+ portions (4 points)
2. How many portions of fruit did you typically eat each day?
(1 portion = 1 medium piece, 2 small pieces, 1 cup diced, or 1 ounce/30g dried)
Select one...
0 portions (0 points)
1 portions (1 point)
2 portions (2 points)
3 portions (3 points)
4+ portions (4 points)
3. How many portions of nuts or seeds did you typically eat each week?
(1 portion = 1 ounce/30g nuts or 1 tablespoon of seeds)
Select one...
0 portions (0 points)
1-3 portions (1 point)
4-6 portions (2 points)
7+ portions (3 points)
4. How often did you eat legumes (e.g., canned beans, lentils, chickpeas, split peas, dried beans) each week?
Select one...
Never (0 points)
Less than 1 day (1 point)
1-2 days (2 points)
3-5 days (3 points)
6-7 days (4 points)
5. How often did you eat a high fibre breakfast cereal (e.g., bran, oats) each week?
Select one...
Never (0 points)
Less than 1 day (1 point)
1-2 days (2 points)
3-5 days (3 points)
6-7 days (4 points)
6. How often did you choose whole-grain pasta and brown/wild rice instead of white pasta and white rice?
Select one...
Never (0 points)
Rarely (1 point)
Sometimes (2 points)
Mostly (3 points)
Always (4 points)
7. How often did you choose whole-grain bread, crackers, or wraps instead of white varieties?
Select one...
Never (0 points)
Rarely (1 point)
Sometimes (2 points)
Mostly (3 points)
Always (4 points)
8. How often did you eat other whole grains (e.g., quinoa, buckwheat, freekeh) each week?
Select one...
Never (0 points)
Less than 1 day (1 point)
1-2 days (2 points)
3-5 days (3 points)
6-7 days (4 points)
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