Nutrition with Therese

Therese Conlon-Barratt
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Nutrition and lifestyle questionnaire

1. Any Health conditions?

7. Systems and symptoms review - tick any of the conditions that you regularly experience?


Nervous System

Endocrine System

Reproductive - Female

Reproductive - Male


Respiratory & cardiovascular system



8. Mental wellbeing & lifestyle

Do you enjoy and find your job rewarding?

Have you recently moved house/changed jobs/been bereaved?

Do you feel guilty when relaxing?

Do you sleep well?

Do you smoke?

Do you drink alcohol?

Do you exercise?

9. Typical food intake over 5 days

13 + 11 =

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