Diet And Nutrition Survey Template
Name:
Date of birth
Do you have any allergies/intolerance to food? Please list them below.
Has your child had bodily pain or discomfort for an extended period of time?
How many servings of fruits and vegetables do you consume in a day?
How often do you consume red meat in a week?
How much caffeine do you consume in a week?
Do you follow a schedule for your meals?
How often do you eat fast food?
What are your comfort foods?