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Nutritional Audit

This is to help us create your implementation plan.

Name

Rate these from 1-10

(1= this doesn’t apply to me, 5= I kinda struggle with this, 10= I struggle with this, please help me!!)

1. During Meals

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I tend to overeat because:

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2. Between Meals

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3. Others

Answer YES or NO, or how much/how many (when applicable)

I restrict on the foods I love so I end up binging:

I don’t have time to cook:

I enjoy cooking:

I have a good relationship with food:

I know how to eat healthy:

I know how to eat healthy, I just don’t do it:

I find it difficult to resist food:

I have a “go hard or go home” mentality:

I have a perfectionist mentality:

I’m scared of failing/making mistakes:

I have a hard time distinguishing hunger from cravings/emotional eating:

I feel tired most of the time:

In the past, I’ve eaten when I was tired:

In the past, I’ve had trouble with cravings:

In the past, I’ve eaten when I was stressed:

In the past, I’ve eaten when I had unwanted emotions/thoughts:

4. Others

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