Nutritional Evaluation

Weight
Nutrition
Is your spouse, fiancee or partner overweight?
Do you use a shopping list?
Do you drink coffee or tea?
Do you drink cola drinks?
Do you drink alcohol?
Do you use a sugar substitute?
Butter?
Margarine?
Do you awaken hungry during the night?
What? How much? When?
When you are under a stressful situation at work or family related, do you tend to eat more?
Do you think you are currently undergoing a stressful situation or an emotional upset?
Smoking Habits: Do you currently smoke?
Energy Level
Activity Level:
(answer only one)
Behavior Syle
Behavior style:
(answer only one)