Nutrition Questionnaire
Name *
Your answer
Is your energy low? *
Details:
Your answer
Is your physical strength limited? *
Details:
Your answer
Do you drag yourself out of bed in the morning? Do you wake up feeling like you pulled an all nighter? *
Details:
Your answer
Do you long for a nap every afternoon? *
Details:
Your answer
Are you having difficulty adapting to the stress you are currently under? *
Details:
Your answer
Are you having trouble sleeping? *
Are you having trouble staying awake?
Details:
Your answer
Do you smoke / digest marijuana or any other drugs? *
Do you consume alcohol? *
Details
Your answer
Is your sex drive M.I.A.? *
Details:
Your answer
Trouble recovering after over-indulging in food or alcohol? *
Details:
Your answer
Do your hangovers include sugar-binging? *
Details:
Your answer
Are you able to get the performance you desire out of your body? *
Details:
Your answer
Do you weigh more than a doctor recommends? *
Details:
Your answer
Is your body depositing fatty tissue where it has never been before? *
Details:
Your answer
Concerning your weight, what do you want? *
Details:
Your answer
Do you eat breakfast every morning? *
Do you eat lunch everyday? *
Do you eat dinner every night? *
Do you cook your meals? *
Do you take any supplements and/or vitamins? *
Details:
Your answer
Do you have flabby upper arms? *
Details:
Your answer
Do you have sagging skin on your face or neck? *
Details:
Your answer
Do you have hot flashes and/or brain fog? *
Details:
Your answer
Do you have depression, anxiety, or mood swings? *
Details:
Your answer
Do you have problems with focus, memory, concentration, or other cognition issues? *
Details:
Your answer
Do you have high cholesterol, elevated triglycerides, or low HDL? *
Details:
Your answer
Do you have high blood pressure? *
Details:
Your answer
Do you have systematic inflammation? *
Details:
Your answer
Do you have high blood sugar, are you insulin resistant, or have you been diagnosed with diabetes? *
Details:
Your answer
Have you been diagnosed with a disease or disorder? *
Are you on any prescribed medication? *
Details:
Your answer
Anything else you would like to share?
Your answer
Thank you!
Thank you for taking the time to help us coach you more efficiently in this journey! -Team CRF
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