Questionnaires
Date:- 10/Apr/25
1. Basic details:-
a) Name:- xyzzy
b) Age:- used to identify intake, appetite, any age-related problems, and to
provide calories according to it .Texture of foods will change(young
preferred crunchy, for elder soft easy to gulp)
c) Gender:- important to check IBW.
d) Professional:- Timing will be changed according to their work and
travelling hours.
e) Phone number:- for contact and to send reminders.
f) Email address:- for contact and to send reminders.
g) Location:- foods will differ based on their location, south Indian(rice
based helps to identify problems), Gujarati(generally eats sweets) and
food will be given based location.
2. Medical condition
a) Current/ recent report:- any condition like diabetes, hypertension.
b) Family history:- to identify causes.
3. Food recall
a) All meals:-from 1st meal of the day to last meal till end of the day.
b)Every small snacks/ munching:-helps to identify cravings and eating
habit.
c) Allergies:-soy, peanut, eggs , wheat(gluten), milk etc.
d)Oil intake:- ask monthly oil intake (1/2 liter for single person)
e) Sugar intake:-
f) Location of food consumed:- outside or at home
g)Addiction:-cigarettes, alcohol or tobacco
h)
4. Activity level, sleep routine and stress management.
a) Activity level:- helps to identify how active they are.
b) Sleep:- explain sleep pattern as late-night sleeps also involve small snacking
and sleep has an important role to provide effective result of meal plan.
c) Stress management:- improper stress management effect meal plan stress, as
stress increases cortisol that has many effects on the body.
Important practical points for Diabetes, PCOD and weight loss
Diabetes PCOD Weight loss
Jaggery, honey and Minimize use for plastic,Starving doesn’t help
sugar are all same paraben and BPA- with fat loss; it also
contain xenoestrogen causes protein loss.
Involve exercise for 4- Involve exercise for 4- Involve exercise for 4-
5days/week improve 5days/week- reduce 5days/week- helps in
blood glucose level cortisol and helps in weight loss and improve
hormonal balance muscle building.
Avoid high glycemic Notes your periods date, Don’t always count
foods- sugar, refined helps to track cycle. calories. Focus on
flour, white rice etc. healthy diet.
Stress can increase Proper stress Don’t skip carbs from
blood glucose level due managements are your meal incorporate
to release of cortisol. important as it can cause complex carbs.
hormonal balance.
Choose healthy snacks- Healthy snacks Only green tea will not
Nuts, seed and makhana. Pumkin, sunflower, help with weight loss, it
Control portion sesame and flaxseeds. accelerates BMR.
size(handful)
7–9 hrs./night 7–9 hrs. poor sleep 7–9 hrs. improve
manage night-time worsens hormonal appetite control
snacking imbalance
1.5-2 liters of water 1.5-2 liters of water 1.5-2 liters of water
should be consumed should be consumed should be consumed
High-fiber vegetables Fiber is Essential for gut Vegetables help in
help with blood sugar health and hormone fullness and fat
control. detoxification. metabolism
Questions
Medical History
1. Do you have any current or past medical conditions?
Please mention if you’ve been diagnosed with conditions like diabetes,
hypertension, thyroid issues, digestive disorders, etc.
2. Have you recently undergone any blood tests or health check-ups?
If yes, can you share the latest report details or upload a copy?
3. Does anyone in your family have a history of medical issues?
(For example: diabetes, obesity, heart disease, anemia, allergies, etc.)
Food Recall
1. Can you describe your typical daily meals?
From the first thing you eat or drink after waking up to your last meal before
bed.
2. Do you usually snack between meals? If yes, what do you prefer?
(Example: biscuits, namkeen, chocolates, fruits, tea, etc.)
3. Do you have any known food allergies or intolerances?
(e.g., lactose, gluten, peanuts, eggs, soy, etc.)
4. What types of cooking oils do you use at home?
How much oil do you think your household uses in a month?
5. How often do you eat sweets or consume sugary foods/drinks?
Are there specific times or moods when you crave sugar?
6. Where do you usually eat your meals?
(Home-cooked, restaurant/takeaway, tiffin service, office canteen, etc.)
7. Do you consume alcohol, tobacco, or smoke?
If yes, how frequently and in what quantity?
1. How active is your daily routine?
Do you engage in any regular physical activity (gym, walking, sports, yoga)?
Please describe.
2. What does your sleep schedule look like?
What time do you usually sleep and wake up? Do you feel rested when you
wake up?
3. How would you describe your stress levels?
Do you feel stressed often? What are your usual stress triggers?
4. How do you usually manage stress or unwind?
(Meditation, music, food, sleep, scrolling social media, etc.)
Dietary Preferences
1. Are you vegetarian, non-vegetarian, vegan, or eggetarian?
2. Any foods you dislike or avoid for personal or religious reasons?
3. Would you like your meal plan to include traditional or cultural foods you
enjoy?
