1 Did you grow up drinking well water, faucet water, bottled water, or filtered water?
Well Water |
2 Did you have home cooked meals as a child, or did you eat fast food and at restaurants growing up?
Home Cooked Meals |
3 How many meals a day did you eat as a child?
4x |
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?
No |
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?
2x |
Where do you normally eat at?
cr chicks, bolay, chipolte, jersey mikes, joseph's |
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?
ice cream, mountain dew, chocolate bar |
11 Do you incorporate whole foods in your nutrition?
Sometimes |
12 Do you eat fruits and vegetables?
Yes |
What are your favorite fruits?
bananas, blueberries, blackberries, grapes, strawberries, apples, peaches, pineapple, kiwi, oranges, almost any fruit |
What are your favorite vegetables?
cauliflower, snap peas, carrots, broccoli, squash, tomatoes, spinach, asparagus, brussel sprouts, sweet potatoes |
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
|
Please type the nutritional lifestyle that you follow
|
16 Do you eat to live or live to eat?
Eat to Live |
17 What is your relationship with food?
I eat when I am hungry |
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?
No |
If so, please list all food allergies and intolerances in detail
|
21 How many ounces, cups or gallons of water do you drink a day?
usually, 64 ounces or more a day |
22 What type/brand of water do you mostly drink?
faucet filtered water or Publix spring water |
23 Are you a coffee drinker?
Yes |
How many cups of coffee per day do you drink?
2 |
24 Do you consume energy drinks, soda/pop, or other caffeinated beverages?
Yes |
If so, please list them in detail.
Most days will drink 1 - 2 coffee black in the morning and an Arbonne energy fizz in the afternoon (I started drinking coffee about 5 years ago and it is not a "have to have" item in the morning. My morning wake up is a shot of OJ) |
25 Please list in detail what a typical day of eating looks like.
First thing in the morning I have a small amount of OJ (couple sips). Then will have either some cottage cheese and fruit (usually blueberries) or a banana (usually around 6am). Next I will have a cup (or 2) of coffee (8am) and then 2 eggs and ham or avocado (10am). Lunch around noon is usually an atkins frozen dinner (meatloaf w/veges or chessy chicken cauliflower). Afternoon snack around 3 can vary from raw veggies to granola bar to meat sticks and cheese. And then dinner time can range from 6pm - 9pm depending on the after school activities of the day - and Dinner will consist of a protein (chicken, steak, shrimp) veggies (usually mix - corn, peas, green beans, asparagus) and either brown rice or sweet potatoe. |
26 Is there anything else you would like to share in this section that wasn’t mentioned? Remember all information is confidential.
Didn't see much about dairy - I love Cheese (almost any kind). I also eat yogurts - with fruit already mixed in. |
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