Download Free Diet Questionnaire Form

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Download Free Diet Questionnaire Form

Download and use this form for maintaining the diet records of a patient.

The following are the questions that are specially meant to increase your knowledge and awareness of your overall diet and to highlight the potential areas of concern. Please answer in Yes or No.

  1. Do you drink enough fluids so that your urine is a pale yellow color?
  2. Do you try special or fad diets?
  3. Do you add salt to foods during cooking at the table?
  4. Do you minimize your intake of sweets, especially candy and soft drinks, and avoid adding sugar to foods?
  5. Is your diet well-balanced (including vegetables, fruits, breads, cereals, dairy products, and adequate sources of protein)?
  6. Do you limit your intake of saturated fats (butter, cheese, cream, fatty meats)?
  7. Do you limit your intake of cholesterol (eggs, liver, meats)?

And two more to go, check on the PDF file you download from the below link.

Download Free Diet Questionnaire Form

Download DietQuestionnaireForm.pdf (65KB)

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