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Health Assessment

Thank you for choosing me to be your guide! Please take a few minutes to fill out this comprehensive health assessment. After you submit your assessment, check your email to complete the next steps. 
Have you ever had anyone hold you accountable to your nutrition related goals?
Do you have experience with Antibiotic use?
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 many caffeinated beverages do you consume daily?
Are you on birth control?
How often do you dine out weekly?
Your meal most often eaten out:
What time of the day do you feel most hungry?
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:

Thanks for submitting!