The NUTRITION Audit

The Nutrition Audit will be used to assess aspects about your health and fitness with a focus on nutrition. We will ask you a series of questions to learn about how you're doing with your nutrition so we can help you reach your goals.

Confidentiality statement

We will respect your privacy. No information about who you are will be given to anyone or be published without your permission, unless required by law. For example if you have an illness that could spread to others, if you or someone else talks about suicide (killing themselves), or if the court orders us to give them the questionnaire data. The data produced from this questionnaire will be stored in a secure location. Only members of the Wells Group Team will have access to the data. This could include Wells Group Integrated Support Team members. Published program results will not reveal your identity but will report group mean and other group statistical data.

A Few Questions about your current NUTRITION patterns...

Please answer the following questions to the best of your ability.

Name *
Name
Date
Date
TELL US WHAT YOU EAT, WHEN YOU EAT, AND ANY URGES YOU MAY HAVE. FOR A TYPICAL WEEKDAY, (CHOOSE FROM ONE OF TUESDAY, WEDNESDAY OR THURSDAY), PLEASE ESTIMATE YOUR FOOD, DRINK AND SUPPLEMENT INTAKE AND CONSIDER THE FOLLOWING QUESTIONS: