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Breakfast Example

Please provide a description of what’s typically included in your breakfast meal. Give two examples.

Lunch Example

Please provide a description of your typical lunch menu. Give two examples.

Dinner Example

Please provide a description of the foods that are typical in your dinner menu. Give two examples.

Snack Examples

Please provide a description of the types of foods you eat for snacks and how often do you need to snack?

How long have you’ve been eating in this manner?

Diet Miscellaneous

Do you drink alcohol?

Do you consume caffeine? (coffee, tea, soda pop, green tea, chocolate (including dark chocolate and raw cacao)

Do you crave sugar and/or carbs?

Do you crave anything else?

Do you drink bone broth?

Do you consume fermented/cultured foods?

Do you consume sugar?

Do you consume other sweeteners besides sugar like honey, maple syrup, molasses, coconut sugar, agave etc.) ?

Do you consume artificial sweeteners?

Do you consume grains?

Do you consume legumes?

Do you consume animal protein? How much per meal?

How many ounces of vegetables do you eat per day?

How much fruit do you eat per day?

How many meals per day do you eat?

How many nuts or seeds do you eat per day?

Do you have problems maintaining blood sugar? (e.g. trembling, shaking, nervousness, irritability, headaches, weakness, ravenous hunger between meals, mental confusion, heart palpitaions)

Have you ever been a vegetarian?

Are you Paleo? If so, how long?

Food Sensitivities

Please list food sensitivities you are aware of.

Diet Other

Is there anything else you’d like me to know about your diet?

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