HEALTH AND PERFORMANCE REPORT WITH CHECKLIST

Nutrition

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* 1. How often do you shop for groceries per week?

once per week

twice per week

more then twice a week

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* 2. Do you meal prep?

yes

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* 3. Average meals per day:

once

twice

three times

three or more times

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* 4. Do you microwave your food more than:

once per day

twice per day

three or more times per day

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* 5. Do you eat vegetables in fewer than two meals per day?

yes

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* 6. Do you find you shopping basket is predominantly packaged foods?

yes

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* 7. Do you find you consume things like: bread, pasta, rice and do they take up most of your plate within your meals?

yes

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* 8. How often do you consume takeaway fast food?

once per week

twice per week

3 times per week

more than 3 times per week

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* 9. Do you consume sugary foods?

once per week

three times per week

four times per week

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* 10. How often do you drink coffee or caffeinated drinks?

once per day

twice per day

three or more times per day

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* 11. How often do you consume alcohol?

twice per week

three times per week

once per day

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* 12. Are you or have you been a smoker?

never

past

currently

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* 13. How often do you consume fried foods particularly with hydrogenated oils e.g vegetable canola oil?

never

once a day

once per week

twice per week

three times week

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* 14. Do you drink tap water?

yes

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* 15. Do you believe you need to eat less to drop body fat and increase your vitality and health?

yes