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Diet Questionaire
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Indicates required field
Name
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First
Last
List 5 meals you think is low in calories and are usually consumed in your diet.
1st meal
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2nd meal
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3rd meal
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4th meal
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5th meal
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List 5 meals you consumed for the past 30days
1st meal
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2nd meal
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3rd meal
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4th meal
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5th meal
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Do you have any food allergy?
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Please select
YES
NO
If yes, please state the food you will have allergy reaction.
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Do you prefer vegetarian diet?
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Please select
YES
NO
Which country food do you eat? Choose Any
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THAI CUSINE
CHINESE CUSINE
JAPANESE CUSINE
INDIAN CUSINE
SPANISH CUSINE
MEXICAN CUSINE
SWEDISH CUSINE
ITALY CUSINE
GERMAN CUSINE
CUBAN CUSINE
EGYPTIAN CUSINE
GREEK CUSINE
KOREAN CUSINE
TURKISH CUSINE
When do you spend your time eating more food than usual?
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At home when stressed
Eating out during weekend with friends for a meal
Meet up with clients
None of the above
Please state here for other reasons
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How many Litre of water do you drink daily?
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How many cup of coffee/tea or caffeinated drinks do you drink daily?
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What type of sugar drinks and how many canned beverage do you drink daily?
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Please select
No, i dont drink canned drinks
1can
2cans
3cans
more than 4cans
Please write down the name of the sugar canned drinks
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Do you know, despite drinking moderate amount of alcohol is safe for our health but the metabolism function in our body is temporarily blocked due to priority set at the moment is to detox alcohol content out of our body?
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Please select
YES I UNDERSTAND
NO
Do you try to consume as much Micronutrients as possible for your meals throughout the day?
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Yes
Partially, at least one meal
Not at all
DECLARATION
By clicking “SUBMIT button”. I declare that the answers I have given are to the best of my knowledge, true and that I have not withheld any material information that may influence the assessment or diet plan and I also understand that a suggested diet plans involve health risk and will not hold SF Fitness coaches (UEN: 53418798J) against any liability or claims for any health problems nor deterioration in social, physical, emotional, spiritual and intellectual. I confirm that there has been no change in my health status since the completion of this questionnaire. All information will be kept confidential.
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AGREE
Submit
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