1 Did you grow up drinking well water, faucet water, bottled water, or filtered water?
Bottled 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?
Packed a 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?
No |
If so, how many times in a week?
|
What types of alcoholic drinks do you consume?
|
Are you an alcoholic?
|
Do you use drinking alcohol to numb yourself from your traumas, pains, and problems?
|
If Yes, Please Explain
|
Why do you drink alcohol?
|
How old were you when you had your first alcoholic beverage?
|
8 Do you currently eat fast food and at restaurants?
Yes |
If so, how many times in a week?
3x |
Where do you normally eat at?
Longhorn, panda, bolay |
9 Do you cook your meals at home?
Yes |
If so, how many times in a week?
3x |
10 Do you currently consume sugary foods or desserts?
Yes |
If so, how many times in a week?
4x |
What do you eat?
I have homemade ice cream at night |
11 Do you incorporate whole foods in your nutrition?
Sometimes |
12 Do you eat fruits and vegetables?
Sometimes |
What are your favorite fruits?
strawberry pomegranate apple |
What are your favorite vegetables?
cherry tomatos or roma tomatos, carrots, patotos |
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?
Yes |
Which nutritional lifestyle do you currently follow
Other |
Please type the nutritional lifestyle that you follow
try to be health |
16 Do you eat to live or live to eat?
Eat to Live |
17 What is your relationship with food?
I eat it to try to help me become better. and to stay alive |
18 Are you an emotional eater?
No |
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
emailed to you |
21 How many ounces, cups or gallons of water do you drink a day?
1 gallon |
22 What type/brand of water do you mostly drink?
Zepyrhills |
23 Are you a coffee drinker?
No |
How many cups of coffee per day do you drink?
|
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.
Breakfast is the harder for me it really varies sometimes I will try to make healthy French toast with sugar free syrup which is probably not good other times I will have a bagel with avocado or oatmeal. For lunch I usually try to have chicken, rice and broccoli or some sort of fish. For dinner I'll have steak, turkey, pretty much anything. |
26 Is there anything else you would like to share in this section that wasn’t mentioned? Remember all information is confidential.
|
consultation_post_id
|
