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dietitian questionnaire

In order to help Dina prepare for your nutrition consultation, please answer the questions below as accurately and thoroughly as possible.

Name *
For example: Breakfast 7am: oatmeal with milk, banana; 16 oz coffee with half and half Snack 10am: Clif bar 11am: usually do 45-75 min run or swim Lunch 12:30pm: turkey and swiss on rye, apple 3pm: crackers with hummus, cheese stick. Sometimes small cappuccino 5pm: strength workout 3x/week 7:30pm: chicken breast, broccoli, wild rice with butter; usually have gelato afterwards