Children under the age of five years, people who are pregnant and lactating, people with tuberculosis, and people suffering from acute malnutrition are eligible to fill the nutrition intake form.
What is your name?
What is your weight?
What is your height?
How many meals do you eat per day?
What types of food do you typically eat for each meal?
Do you eat any snacks during the day?
Do you drink any beverages other than water?
What is your overall intake of calories per day?
What is your overall intake of protein per day?
What is your overall intake of fat per day?
What is your daily water intake in ounces?
Do you have any allergies?
Do you have any medical conditions?