Anyone who is interested in learning more about their diet's nutritional content can complete this nutrition assessment form.
What is your name?
How many calories do you eat in a day?
What is your daily intake of fat?
What is your daily intake of protein?
What is your daily intake of fiber?
How many meals do you eat per day?
How often do you eat fast food, take-out, or processed foods?
What is your diet like?
What is your daily water intake like?
Do you eat breakfast every day?
Do you skip meals?
Do you take any vitamin or mineral supplements?
Do you have any food allergies?
Do you have any medical conditions?