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Nutritional Consultation Questionnaire

  Nutritional Consultation Questionnaire 



Sickness type:
Instructions:  
When you get sick are you prone more to fevers based or more mucus based illnesses?
Sickness type: [required]
Describe your fluid intake:
Instructions:  
In your day to day how many fluids do you intake (ie; soup, smoothies, teas, water, artificial mixes)?
Fluid intake: [Required]

Character Count: 
Max Allowed Characters: 3000   |   Min Allowed Characters: 10
Fasting:
Instructions:  
Have you ever participated in fasts, or intermittent fasting?
Fasting: [required]
Fruits and Vegetables:
Instructions:  
How many times per week do you eat vegetables? fruits?
 Fruits and Vegetables: [Required]
Max Allowed Characters: 200   |   Min Allowed Characters: 1
Bowels:
Instructions:  
How frequent are you Bowels?
 Bowels: [Required]
Max Allowed Characters: 200   |   Min Allowed Characters: 1
Health perceptions:
Instructions:  
What are your ideals or perceptions around health? physical, mental, emotional, spiritual?
Health perceptions: [Required]

Character Count: 
Max Allowed Characters: 3000   |   Min Allowed Characters: 10
Stature:
Instructions:  
Please describe your stature (ie; skinny, toned, curvy, over weight) over the major time periods of your life (baby, pre- pubescent, post pubescent, adulthood).
Stature: [Required]

Character Count: 
Max Allowed Characters: 3000   |   Min Allowed Characters: 10
Skin moistness:
Instructions:  
Is your skin usually dry or naturally moist?
Skin moistness: [required]
Best season:
Instructions:  
Which season do you feel your best in?
 Best season: [Required]
Max Allowed Characters: 200   |   Min Allowed Characters: 1
Most active period:
Instructions:  
When are you most active: night or day?
Most active period: [required]



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