mind alive David - PERSONAL PROFILE QUESTIONNAIRE; VI. NUTRITION

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PERSONAL PROFILE QUESTIONNAIRE
VI. NUTRITION
1) Do you include fresh fruits and vegetables in your diet?
 No
 Yes How much? _______________________________
7) Do you eat green leaves or seaweed?
 No
 Yes How much? _______________________________
8) How many cups of water do you drink daily? ____________
9) Does your diet contain artificial colors, preservatives or
additives?
 No
 Yes
10) Do you drink sodas or carbonated drinks?
 No
 Yes How many cans/bottles daily?___________
11) Do you drink coffee or caffeinated drinks?
 No
 Yes How many cups per week? ______________
12) Do you smoke cigarettes or marijuana?
 No
 Yes How many per week? ____________________
13) Do you drink alcohol?
 No
 Yes How many drinks per week? ____________
14) Do you use white sugar and/or products with refined flours?
 No
 Yes
15) Do you need comfort foods (chocolate, fried food, red meat, etc.)
 No
 Yes What foods? _______________________________
16) Do you take vitamin supplements?
 No
 Yes