Diet Survey

1 Your Condition

2 Your Diet & Lifestyle

No
Yes
No
Yes
Choose all that apply
Choose all that apply
Choose all that apply
Choose all that apply
None
A lot
None
A lot

3 Meat, Poultry, Fish & Eggs

4 Milk & Dairy

5 Grains, Beans & Legumes

6 Vegetables

7 Fruit

8 Nuts, Sugars & Other Foods

9 Drinks

10 Complete