NUTRITION QUESTIONNAIRE Name * First Name Last Name Email * Phone * (###) ### #### Do you have any food allergies or food intolerances? Have you ever been on a diet? If yes, what diets have you tried? How often do you cook & eat at home? How often do you eat out? Who cooks your food? How often do you drink alcohol? What are your favorite foods? (As of recent) What can’t you live without or would have trouble parting with if you were to follow a diet? What are your least favorite foods? Write a detailed account of what you eat in a day. (Include time you eat, wake-up, bed times, exercise time) (You can simply write what you ate yesterday) Thank you! Charlie Anzaldo • Tru Nature
