Instructions and summary for building ACLM's WFPB Diet Screener as an online survey

ACLM Diet Screener

Thank you for your interest in the ACLM Diet Screener

This brief questionnaire will allow your patients to track their usual diet over the last 4 weeks. Download and use the PDF version or use the design elements to build your own screener.

The links below will take you to the ACLM Connect platform, which houses all downloadable resources. You will need to make a free account to login and download the screener files. If you do not already have an ACLM Connect account, you will be prompted to create a free account.

Version 1. Date Updated: December 15, 2023.

Instructions, scoring, and screener as .pdf

Elements for online surveys

To build the screener online, we offer you a .zip file of each food element with and without text descriptions.


The final list of food was approved by the study team. Following approval by the team, the screener was then submitted to a professional designer to create a colorized PDF version with photos depicting the food examples as well as a more simple, black and white PDF version. For ease of use in online settings, images of the food examples were made available.