Veggie Up!! Pre-Assessment
How many servings of cooked vegetables do I eat on average each day?
How many servings of fresh vegetables do I eat on average each day?
How many servings of fruit do I eat on average each day?
How many times per week do I eat out?
How many servings of processed food do I eat on average each day? (This includes anything that comes in a box, or has more ingredients than simple whole foods.)
How many servings of red meat do I eat on average each day?
How many servings of poultry do I eat on average each day?
How many servings of fish do I eat on average each day?
How many servings of dairy do I eat/drink on average each day?
How many servings of refined grain do I eat on average each day?
How many servings of whole grain do I eat on average each day?
Do I crave certain foods?
How do I feel physically on average? (1=poor, 10=fantastic)
Describe
How do I feel emotionally on average? (1=poor, 10=fantastic)
Describe
Do I take medications?
Do I take supplements?
Am I pregnant or breastfeeding?
Are there any concerns?
Explain