DIET PLAN

Diet Questionaire

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Name *

First

Last

List the top 3 meals you had frequently consumed for the past 30days during breakfast. Kindly state the estimated serving size( eg, palm size, fist size, ml )

1st meal *

2nd meal *

3rd meal *

List the top 3 meals you had frequently consumed for the past 30days during Lunch. Kindly state the serving size( eg, palm size, fist size, ml)

1st meal *

2nd meal *

3rd meal *

List the top 3 meals you had frequently consumed for the past 30days during Dinner. Kindly state the serving size( eg, palm size, fist size, ml)

1st meal *

2nd meal *

3rd meal *

List the top 3 snack you have consumed fior the past 30days? *

When do you spend your time eating more food than usual? *

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 *

How many litre of water do you drink daily? *

How many cup of coffee/tea or caffeinated drinks do you drink daily? *

What type of sugar drinks and how many canned beverage do you drink daily? *

Please write down the name of the sugar canned drinks *

Do you try to consume as much Micronutrients as possible for your meals throughout the day? *

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.

AGREE

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