Maddox Smith Staff asked 4 years ago

Clinical Nutrition

Do you suffer from any food allergies or intolerances?  If yes please give details : ……………………………………………………………… Are you taking any vitamin/mineral preparation or other nutritional  supplement ?  If yes please give details: …. How many meals do you have per day? Four 2. Which type of bread do you usually eat? White Brown/Hovis Granary x Wholemeal None Do you usually buy large or small loaves, sliced or unsliced? Large x Small Sliced x Unsliced 3. What arrangements do you make for the food you eat at lunchtime? Bring lunch from home x Buy food from retail outlet Eat in canteen Don’t eat lunch 4. What arrangements do you make for the food you eat in the evening?  times / wk Cook at home x 7 At home  – Supermarket ready meals Eat out – Restaurant  Takeaway Food  5. What kind of milk do you usually use? Full cream milk  Semi-skimmed milk x Skimmed milk  Soya None How much milk do you drink daily i.e. in tea/coffee/milkshakes etc. > 1 pint (state) x 1 pint (600ml) ½ pint (300ml) ¼ pint (150ml) None 7. What kind of spreading fat do you use? Butter Margarine x Low fat spread Don’t use any Please state which type/brand ……Flora Buttery…………………………….. Do you spread it ……?  Thickly Thinly x 8. What type of fat do you use for cooking? Oil x Butter Margarine Lard Don’t use any Please state which type/brand …Berio Olive Oil……………………………….. 9. How often do you eat food that is fried?Daily 1-3 times/week 4-6 times/week Less than once/week x 10. What do you do with the visible fat on your meat? Eat most of the fat Eat as little as possible x Eat some of the fat Don’t eat meat6 11. How many cups of tea/coffee do you drink per day? 2 or 3. 12. What do you add to tea/coffee? MILK x SUGAR SWEETENER NOTHING How many tablespoons of milk do you take in tea and coffee? _____ tablespoons milk in a cup of tea __2___ tablespoons milk in coffee13. Do you drink alcoholic drinks? YES X NO If YES, how many units you drink in a typical week? 1 unit = ½ pint beer/lager 1 glass wine, 1 measure spirit. __4___ units per week