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Have you ever had anyone hold you accountable to your nutrition related goals?
Do you have experience with Antibiotic use?
Are you on birth control?
Are there any foods that you avoid?
Do you currently take any vitamin/mineral supplements?
Have you ever tried eliminating certain foods or food groups from your intake?
What is your overall level of exercise?
How often do you dine out weekly?
Your meal most often eaten out:
What time of the day do you feel most hungry?
How many caffeinated beverages do you consume daily?
Do you smoke tobacco products?
How many days do you consume alcohol?
How would you rate your quality of sleep?
Do you have troubles falling asleep?
How would you rate your level of stress?
Have you ever been diagnosed with an eating disorder?
Check all that apply to you:
I usually eat breakfast around:
I usually eat lunch around:
I usually eat dinner around:
What is your present level of commitment to change any underlying causes of your signs and symptoms which relate to your lifestyle? (rate from 0 to 10 with a 10 = 100% committed)
Acknowledgment of Financial Policy - I understand the following policy: I am responsible for the total payment of my program, including a program payment plan, after the first counseling session is completed. Subscription cancellations or program holds are not permitted.
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