Please fill out the following questionnaire to give me a better understanding of your current habits.  

Name *
Name
How many servings of fruit do you eat per day? Excluding juice. One serving of fruit is: 1 medium fruit (medium is defined as the size of a baseball); 1/2 cup chopped, cooked or canned fruit. *
How many servings of vegetables do you eat per day? One serving of vegetables is: 1 cup of raw leafy vegetables (About the size of a small fist), 1/2 cup of other vegetables or 1/2 vegetable juice, with no additional ingredients. *
Do you have any issues when eating dairy? *
How many meals do you eat out per day on average? *
How many meals do you eat out per week on average? (Includes breakfast, lunch and dinner) *
Do you eat meat? *
What kind of meat do you gravitate towards? *
How many grain products do you typically eat in a day? (cereal, bread, wrap, doughnut, croissant, bagel, rice, quinoa, oats, granola bar, crackers, etc) *
How often do you grocery shop? *
How much do you budget for food per week (indlucing grocery store and all food bought on-the-go or from restaurants)
Do you typically achieve this?
Do you typically eat breakfast? *
Is it...? *
Do you typically eat lunch? *
Is it ... ? *
Do you typically eat dinner? *
Is it ...? *
How many hours are between your first bite and your last bite? *
How often are you active? (walking, gym, cycling, etc.) *
What is the intensity of your activity? *
What is the nature of your occupation? *
How many hours do you typically sleep for? *
Do you feel rested when you wake up? *

THANK YOU!