HEALTH HISTORY

Any recent Diagnosis?:

Do you have food allergies?:

15 + 12 =

GENERAL

Do you know correct portion sizes?

Is it necessary for you to have meat at each meal?

Have you ever kept a food diary or journal?

When you eat, do you ever feel guilty?

Drink Alcohol?

Do you know how to read food labels?

Do you exercise?

4 + 3 =

GOALS

4 + 2 =