You may be ignorant about the nutritional needs of your body. Our office has devised the following questionnaire to assist the Doctor to determine your nutritional needs.

When you try to answer the following questions, you will find that there are many things that you may be overlooking in your daily life, but these things may be an important factor in keeping you disease free which only a qualified Doctor can advise:

1. How many meals do you have a day?
2. What do you usually have for breakfast?
3. Do you have a mid-morning snack? What?
4. What do you usually have for lunch?
5. Do you have a mid-afternoon snack? What?
6. What did you eat for dinner last night?
7. Do you have a mid-evening snack? What?
8. How many times a week, do you have "fast foods" for lunch     or for dinner?

9. How many cans of soda drinks or diet soda do you have a day?
10. How many hours of sleep do you get in a night, on an average?
11. Do you usually wake up feeling as if you have not rested at all?
12. Are you usually tired during the day?
13. Are you usually tired after meals?
14. If you work, do you usually have trouble concentrating after lunch?
15. How many cups of coffee (regular or decaf) do you have a day?
16. How many glasses of pure water or milk do you drink a day?
17. Do you usually have dessert with lunch or dinner?
18. How often do you eat candy, chocolate, cakes or other sugary foods?
19. How often do you eat fried foods?
20. How often do you eat fresh, uncooked vegetables?
21. How often do you eat fresh fruits?
22. How often do you eat fish, Chicken, Pork & Beef?
23. What is you favourite food in the world?
24. How many alcoholic beverages do you drink a week?
25. Do you take any vitamin or mineral supplements?
26. Do you believe you are not in control of what you eat?
27. Is it more difficult to eat well during week-ends?
28. Do you understand the concept of a "balanced meal"?
29. Are you taking any prescription medication?
30. Are you currently dieting, or have you ever been in a diet?
31. Are you happy with your diet program or do you feel hungry all the time?
32. In general, are you happy with your weight & your appearance?
33. Do you often feel as if you have over-eaten?
34. Do you believe binge-eating or over-eating is related to poor nutrition?
35. Do you suffer from heartburn or belching?
36. Do you often take antacids or bicarbonate?
37. Do you frequently have diarrhoea? From which foods?
38. Do you frequently have constipation? From which foods?
39. Does your stool commonly float? Does it sink?
40. Stool should be brown; is it usually yellow, red or black?
41. Do you have a flatulence problem?
42. Do you take digestive enzymes?
43. Is there a family history of obesity?