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East Jefferson General Hospital Outpatient History Form Continued Food and Nutrition Services Outpatient History Form Please answer each of the questions below. The information you share will help
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How to fill out nutrition and activity self-history
How to fill out nutrition and activity self-history:
01
Begin by gathering all relevant information such as your age, height, weight, and any underlying medical conditions or dietary restrictions you may have.
02
Record your daily dietary intake by keeping a food diary. Include all meals, snacks, and beverages consumed, as well as portion sizes.
03
Note any specific nutritional goals or concerns you may have, such as weight loss, muscle gain, or managing a chronic condition.
04
Document your current level of physical activity, including frequency, duration, and intensity of exercise. This can include activities such as walking, running, cycling, or participating in sports.
05
Be honest and thorough when completing the self-history. Include any medications or supplements you may be taking, as well as any allergies or intolerances you have.
06
Consider seeking the help of a registered dietitian or nutritionist if you require guidance or have complex nutritional needs.
Who needs nutrition and activity self-history?
01
Individuals looking to improve their overall health and well-being.
02
Those with medical conditions such as diabetes, high blood pressure, or heart disease, who need to closely monitor their diet and activity levels.
03
Athletes or individuals engaging in intense physical training, who require proper fueling and recovery strategies.
04
Anyone looking to achieve specific fitness goals, whether it's weight loss, muscle gain, or improved athletic performance.
05
Individuals with food allergies or intolerances who need to track their dietary intake to avoid potential triggers.
Note: It is always advisable to consult with a healthcare professional or registered dietitian before making any significant changes to your diet or exercise routine.
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