Assessment Nutrition Tool
Women's Survey on Health

The Health and Wellness Survey can help you assess your future health by looking at your current nutritional habits.

Do you want to get healthy but don't know where to start? We'll give you sound advise and useful tips to help you get your health back on track in a snap! Try the assessment nutrition tool.

Fill out the survey its FREE and then hit submit at the bottom of the page. A thank you page will pop up with a link to your survey results. Enjoy!

Assessment Nutrition Tool A 16 Question Survey to Your Health Please note that all fields followed by an asterisk must be filled in. First Name* First Name* E-mail Address* E-mail Address* 1. Do you eat more meals with poultry, lean meat, fish and plant (soy) proteins rather than steaks, roasts and other red meats?* 1. Do you eat more meals with poultry, lean meat, fish and plant (soy) proteins rather than steaks, roasts and other red meats?* Yes No 2. Do you eat a variety of colorful fruits and vegetables and do you eat at least seven servings a day of these?* 2. Do you eat a variety of colorful fruits and vegetables and do you eat at least seven servings a day of these?* Yes No 3.Do you consume primarily whole grains (100% whole wheat bread and pasta, brown rice) rather than regular pasta, white rice and white bread?* 3.Do you consume primarily whole grains (100% whole wheat bread and pasta, brown rice) rather than regular pasta, white rice and white bread?* Yes No 4.Do you eat ocean-caught fish at least three times a week?* 4.Do you eat ocean-caught fish at least three times a week?* Yes No 5. Do you usualy eat fried foods, dressings, sauces, gravies, butter and margarine?* 5. Do you usualy eat fried foods, dressings, sauces, gravies, butter and margarine?* Yes No 6. Do you have problems with your digestive system (indigestion or irregularity)?* 6. Do you have problems with your digestive system (indigestion or irregularity)?* Yes No 7.Do you get a minimum of 30 minutes of exercise three to five days a week?* 7.Do you get a minimum of 30 minutes of exercise three to five days a week?* Yes No 8. Are you overweight?* 8. Are you overweight?* Yes No 9. Do you usually have time to prepare balanced meals, rather than take-out or eating on the run?* 9. Do you usually have time to prepare balanced meals, rather than take-out or eating on the run?* Yes No 10.Do you usualy eat soda and typical snack foods throughout the day and after dinner?* 10.Do you usualy eat soda and typical snack foods throughout the day and after dinner?* Yes No 11.Do you have problem with water retention and bloating?* 11.Do you have problem with water retention and bloating?* Yes No 12.Do you have the energy and focus you needs to meet your daily challenges?* 12.Do you have the energy and focus you needs to meet your daily challenges?* Yes No 13. Do you drink at least eight glasses of water a day?* 13. Do you drink at least eight glasses of water a day?* Yes No 14.Are you getting your daily recommended allowance of Calcium?* 14.Are you getting your daily recommended allowance of Calcium?* Yes No 15.Do you have problems with your blood pressure, triglycerides and cholesterol? Yes No 16. Women: Do you have problems associated with your menstrual cycle/menopause such as mood changes, hot flashes or problems sleeping? * 16. Women: Do you have problems associated with your menstrual cycle/menopause such as mood changes, hot flashes or problems sleeping? * Yes NO

End of assessment nutrition tool.