Mydietetics Health Survey

One of the first steps of our work together is to complete the health survey. Please answer the questions as detailed and accurate as possible. It takes about 20 minutes to finish the questionnaire.

Biztosított

Survio

Age

Height

Actual weight (kg)

What would be your ideal weight (kg)?

Body fat % (if you know)

Weight gain and weight loss in the past 6 months (+/- kg)

Do you have any food-related symptoms?

Please list foods which have already caused problems. Please try to be as specific as possible Ex. milk-diarrhoea; onion-bloating, eggs-rash

Existing disease(s), Medical diagnosis (please check your latest medical record)

Examples: diabetes, gout, insulin resistance, asthma, reflux, hypertension, arthritis, joint pain, depression, varicose veins, gallstones,.... etc

Medications

Please specify the amount and frequency of consumption

Food supplements

Vitamins, mineral supplements, protein powder,... etc. amount and frequency

Do you use sweeteners? Which product?

Ex: eritrit, stevia, xilit

Has there been any change in your appetite in the last week?

Increased

Decreased

Unchanged

Other

Did you experience any of these symptoms in the past 2 weeks?

Válassz egy vagy több választ

Nausea

Vomiting

Diarrhoea

Constipation

Normal Stools

Other

Do you smoke?

Yes, regularly

Yes, occasionally

Do you drink alcohol?

Please choose one answer

Not at all

2 times a week

3 times a week

daily

occassionally

Eating and shopping habits

Number of meals per day

please choose one answer

Which statement is specific to you?

Choose one or more answer

I have no appetite in the morning.

In the morning, I rush to eat something on the way.

I eat breakfast at home.

I never eat breakfast.

I often forget to eat all-day.

For lunch, I just grab something quickly.

I don't usually have time to eat lunch.

I eat lunch normally.

I'm always thirsty.

I always get home really hungry.

Dinner is the main meal of the day.

I eat late at night if I get hungry.

I always sit down at the table to eat.

I eat dinner normally.

I always have some kind of snacks with me(chocolate, protein bars, cereal bars, biscuits) etc

I eat snacks all day.

I eat in hurry most of the times.

Other

Total daily fluid intake (l)

ex 2,5 litre water

How often do you eat? 1/4

Select an answer in each row

4-5X daily2-3X dailydaily4-6X weekly1-3X weekly1-3X mothlynever

white bread, buns, rolls,

wholemeal bread, buns, rolls (bran, graham, rye)

pastries, croissants, scones,

natur cereal flakes, muesli

sweet breakfast cerels, granola

rice (as a side dish)

pasta (as a side dish)

How often do you eat? 2/4

Please select an answer in each row

4-5X daily2-3 X daily1X daily4-6X weekly1-3X weekly1-3X monthynever

Pasta, Pizza, Lángos, Sweet pasta dishes

Raw vegatables

Pickles

Főzelék

Legumes

Vegetable side dishes (fried, steamed, salad)

Potato

How often do you eat..? 3/4

Please select an answer in each row

4-5X daily2-3X daily1X daily4-6X weekly1-3X weekly1-3X monthyNever

Raw fruits

Nuts

Dried fruits

Fruit products( compote. jams, canned fruits)

Dairy products (yogurt, kefír, cheese)

Eggs

How often do you eat..? 4/4

Please select an answer in each row

Napi 4-5xNapi 2-3xNapi 1xHeti 4-6xHeti 1-3xHavi 1-3xRitkáb-ban vagy soha

Fish

Cookies, chocolate, sweets, biscuits

salty snacks, chips, nachos, salty biscuits

What kind of snacks do you eat regularly?

What are your favourite foods/dishes?

Any dishes or foods that you can't stand?

Semmiképpen se tervezzük bele a javaslatainkba.

Where do you shop for groceries? How often?

How often do you..? 4/4

please select and answer in each row

2-3X daily1X daily4-6 X weekly1-3X weekly1-3X monthlyNever

Cook at home

Order food (home, at work)

Eat in a restaurant

Eat in a fast food restaurant ( McDonalds, KFC, Burger King)

Eat in a bistro, work canteen, community canteen

On average, how much time do you have to cook every day?

Please choose an answer

Less than 30 minutes

30-60 minutes

More than an hour

On a scale of 1 to 5, how willing are you to cook at home?

1 star - not at all; 5 star - love cooking at home

Do you follow any traditions or dietary trends that affect your eating habits?

Aktivitás

How many hours do you sleep daily?

On average, how many steps do you take in a day?

Please check your step tracking app in your phone or your smart watch

How often do you exercise in a week?

Please choose an answer

I don't do sports at all

Walk

1-2 workouts in a week

3-5 workouts in a week

5-7 workouts in a week

What sports activity is your favourite?

Thank you for completing the questionnaire:)