| 1. Do you eat out more than three times per week? |
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| 2. Do you eat boxed foods more than twice per week? |
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| 3. Do you drink any type of soda? |
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| 4. Do you eat less than 5 servings of vegetables per day? |
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| 5. Do you drink less than 4 glasses of water per day? |
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| 6. Do you feel addicted to certain foods? |
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| 7. Do you typically opt for lower fat and lower calorie foods when given the choice? |
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| 8. Do you eat white flour, white rice, or white bread? |
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| 9. Do you use artificial sweeteners like Aspartame, Splenda, and Nutrisweet, or consume foods that contain them? |
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| 10. Do you eat fried foods more than once per week? |
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| 11. Do you eat processed "deli" meat, bacon, sausage, or hot dogs? |
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| 12. Do you feel you get all your needed nutrients from food, and therefore pass on supplements including multivitamins and fish oil? |
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| 13. Do you use canola oil or vegetable oils in cooking or in salad dressings? |
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| 14. Do you use margarine? |
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| 15. Are most of the fruits and vegetables you eat conventionally grown (non-organic)? |
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| 16. Do you consume milk and dairy products from the grocery store? |
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| 17. Are the majority of your animal products from the meat counter or freezer at the grocery store (as opposed to a health food store or local farmer)? |
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| 18. Do you consider price and convenience of food to be more important than nutritional quality? |
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| 19. Do you eat sweets or candy more than once per week? |
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| 20. Do you drink more than 1 alcoholic beverage, three times per week? |
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| 21. Do you eat while rushed or under stress? |
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| 22. Do you, your doctor or family feel that you should lose some body fat? |
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| 23. Do you have irregular blood sugar, diabetes, or pre-diabetes? |
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| 24. Do you have blood pressure over 115/75? |
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| 25. Do you suffer from sinus issues, asthma, or allergies (including rashes, eczema, hives)? |
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| 26. Do you have gastrointestinal issues? |
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| 27. Do you frequently experience fatigue or insomnia? |
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| 28. Do you have emotional/mental challenges or trouble concentrating? |
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| 29. Do you suffer from joint pain or muscle aches? |
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| 30. Do you have hormonal imbalances? |
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