Nutritional questionnaire Please answer the nutritional questions below. Name * First Name Last Name Email * Briefly describe how you are going, are you happy with your progress or have you been struggling in any way that you would like to discuss? * On a scale of 0 (flat/tired) to 10 (bouncing off the walls), how are your energy levels? * What supplements are you taking? (please be specific with brands, doses and consistency) * Have you been having issues with * Regurgitation/vomiting Dumping (loose bowels, hot flushes, sweats, rapid heartbeat, stomach pain , bloating) Constipation N/A Select which of these mindful eating techniques you are using at each meal * 20 chews 20 second pause between mouthfuls Ending meals at 20 minutes if not before None at the moment Please describe your portion size in general. * Are you eating three meals each day, skipping meals, or having snacks in between meals? * What do you eat on a usual day for breakfast, lunch and dinner? * What carbohydrates are you eating if any daily/weekly? * 1. Carbohydrates (bread, wraps, rice, pasta, cous cous, potato/kumara/corn, chips, crackers, scones, muffins). 2. Fruit. 3. Sweet foods/drinks (ice cream, lollies, fizzy drinks, chocolate). How much fluid are you managing to drink each day and what do you generally choose? * Are you drinking any alcohol, and if so, how often and volume how much? * Thank you!
