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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. Please use the Tab key on your keyboard to move between questions rather than the Enter or Return key.

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