Nutrition Questionnaire for SOS Whole Food Plant Based Mentoring Program

Those of you who are participating in the SOS, free Whole Foods mentorship program. Please answer the following nutrition questions and send your answers back to me via messenger. All information is considered confidential and will not be shared with anyone else. Have a blessed day I look forward to hearing from you, Dr. Bobby and Sue Ellen, RN

  1. Personal Information:

   – Name:

   – Age:

   – Gender:

   – Height (in feet and inches):

   – Weight (in pounds):

   – Occupation:

 

  1. Dietary Habits:

   – How many meals do you typically have in a day?

   – Do you have a regular eating schedule?

   – Do you skip meals often?

   – How often do you eat out or order takeout in a week?

   – Do you have any dietary restrictions or allergies?

 

  1. Food Preferences:

   – Do you have any specific food preferences (e.g., vegetarian, vegan, gluten-free)?

   – Are there any foods that you dislike or avoid?

 

  1. Water Intake:

   – How many glasses of water do you drink in a day?

 

  1. Physical Activity:

   – How often do you engage in moderate-intensity exercise (e.g., brisk walking, cycling)?

   – How often do you engage in vigorous-intensity exercise (e.g., running, swimming)?

 

  1. Supplements:

   – Do you take any dietary supplements? If yes, please specify.

 

  1. Medical History:

   – Do you have any medical conditions (e.g., diabetes, high blood pressure)?

   – Are you currently taking any medications?

 

  1. Weight Goals:

   – What is your current weight goal (e.g., lose weight, maintain weight, gain weight)?

   – If you have a weight loss or weight gain goal, how many pounds would you like to lose/gain per week?

 

  1. Additional Information:

   – Is there any additional information or specific concerns you would like to share regarding your nutrition?

 

Please provide your responses to the above questions, and I will be able to provide you with personalized nutrition recommendations.

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