1 Did you grow up drinking well water, faucet water, bottled water, or filtered water?
Filtered Water |
2 Did you have home cooked meals as a child, or did you eat fast food and at restaurants growing up?
Both |
3 How many meals a day did you eat as a child?
3x |
4 Did you pack a lunch to school, or did you eat the school’s breakfast and lunch?
Ate school’s breakfast and lunch |
5 Did you drink a lot of sodas, juices, or kool-aid growing up?
Yes |
6 Did you eat junk food and candy as a child?
Yes |
If so, how many times a day?
1x |
7 Do you currently drink alcohol?
Yes |
If so, how many times in a week?
2x |
What types of alcoholic drinks do you consume?
tequila/vodka shots, cocktails like lemon drops and margaritas |
Are you an alcoholic?
No |
Do you use drinking alcohol to numb yourself from your traumas, pains, and problems?
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If Yes, Please Explain
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Why do you drink alcohol?
social drinking |
How old were you when you had your first alcoholic beverage?
14 |
8 Do you currently eat fast food and at restaurants?
Yes |
If so, how many times in a week?
2x |
Where do you normally eat at?
I rarely eat fast food anymore, it's mostly dining at restaurants i.e. joeys, steakhouses, etc. |
9 Do you cook your meals at home?
Yes |
If so, how many times in a week?
4x |
10 Do you currently consume sugary foods or desserts?
Yes |
If so, how many times in a week?
2x |
What do you eat?
Occasionally I'll have a couple pieces of candy or a chocolate bar like a snickers or twix |
11 Do you incorporate whole foods in your nutrition?
Sometimes |
12 Do you eat fruits and vegetables?
Yes |
What are your favorite fruits?
strawberries, watermelon, apples, bananas |
What are your favorite vegetables?
broccoli, asparagus, spinach, squash/zucchini |
13 Do you purchase organic produce?
No |
If so, what produce do you buy organic?
|
14 Do you purchase organic groceries?
No |
If so, what groceries in particular do you buy organic?
|
15 Do you follow any particular diet or nutritional lifestyle?
No |
Which nutritional lifestyle do you currently follow
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Please type the nutritional lifestyle that you follow
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16 Do you eat to live or live to eat?
Live to Eat |
17 What is your relationship with food?
When I'm caring for myself, I only like to eat when I'm hungry and will eat until I feel full. But there are days where I can binge eat all throughout the day. But I love food and it's incorporated with how I socialize with friends and family. |
18 Are you an emotional eater?
Yes |
19 Do you struggle with cravings?
No |
If so, what foods do you crave?
|
20 Do you have any food allergies or intolerances?
Yes |
If so, please list all food allergies and intolerances in detail
Dairy--I can't have too much cheese, I don't drink whole milk--usually swap for oat or almond milk.
I'm allergic to crab and lobster and will break out in eczema the next day, but if I eat a LOT then I would have an itchy throat and mouth as well. |
21 How many ounces, cups or gallons of water do you drink a day?
About 6 cups |
22 What type/brand of water do you mostly drink?
I usually go for sparkling when I am out. I have filtered water at home. Bottled water is usually smartwater, essentia, kirkland mostly. When I'm out, I either drink vitamin waters or the Dasani/Aquafina brands available. |
23 Are you a coffee drinker?
Yes |
How many cups of coffee per day do you drink?
1 |
24 Do you consume energy drinks, soda/pop, or other caffeinated beverages?
No |
If so, please list them in detail.
|
25 Please list in detail what a typical day of eating looks like.
Start with coffee and either I make a breakfast sandwich or eggs/toast, or a fruit. Then I'll eat leftovers or make something quick at home for lunch, and then dinner is eating either a homecooked meal with my mom or dining out. Then sometimes I snack in the evenings. |
26 Is there anything else you would like to share in this section that wasn’t mentioned? Remember all information is confidential.
Sometimes I get too busy or stressed that I don't get hungry and so I don't really eat until the evening. |
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