A week before your nutrition appointment, try your best to take a moment after you eat to document a detailed description of what you ate. It doesn't need to be perfect; if you skip a day, its okay, make sure to keep going! Make sure that you also try to document your water intake, quality of sleep, and bowel movements. having everything down on your long helps us see patterns that there might be. 

 
 
 

Circle the number that applies to you. If the symptom does not apply, don't circle anything for that symptom. If you are a female, do not answer the male questions, and if you are male do not answer the female questions. If you are unsure of a question, leave it blank and ask us when you come to your appointment.

1= Mild symptom rarely occurs

2= Moderate symptom occurs several times per month

3= Severe symptom occurs almost constantly

 

Remember to print your score!

Rate each of the following based upon your health profile for the past 90 days.

 
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How well do you think you are handling stress? This assessment will help us design a personalized program to support your stress response and well-being.