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ADOLESCENT Nutrition Screening Questionnaire
Ages 13 to 17 years old
Date:Clinician:Name:Birth date:Circle one: Female/ Male
Would you like to schedule an appointment with the Dietitian? YES / NO
Please
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How to fill out adolescent nutrition screening questionnaire
How to fill out adolescent nutrition screening questionnaire:
01
Start by carefully reading the instructions provided with the questionnaire. It is important to understand the purpose of each question and how to respond accurately.
02
Answer each question honestly and to the best of your knowledge. The questionnaire aims to assess your eating habits, nutrient intake, and any potential risk factors related to your nutrition.
03
Take your time to consider each question before responding. If you are unsure about a particular question, it is advisable to seek clarification from a healthcare professional.
04
Provide accurate information regarding your age, height, weight, and any medical conditions or allergies you may have. This will assist in assessing your specific nutritional needs.
05
Share details about your daily dietary intake, including the types of food you consume, portion sizes, and frequency of meals and snacks. This information helps evaluate your overall nutritional status and identify any dietary deficiencies or imbalances.
06
Answer questions related to physical activity and sedentary behaviors. Including this information helps assess your level of physical fitness and determine if modifications to your diet or activity level are required.
07
Consider any concerns or areas of interest you may have about your nutrition. The questionnaire is an opportunity to discuss specific issues or seek advice on improving your dietary habits.
08
Upon completion, review your responses to ensure accuracy and completeness. Make any necessary corrections or additions before submitting the questionnaire.
Who needs adolescent nutrition screening questionnaire?
01
Adolescents who want to assess their overall nutrition and make informed decisions about their dietary habits may benefit from completing the adolescent nutrition screening questionnaire.
02
Healthcare professionals, such as registered dietitians or pediatricians, often use the questionnaire to evaluate an adolescent's nutritional needs, identify any potential issues or deficiencies, and provide appropriate guidance and recommendations.
03
Schools, community organizations, and research institutions may utilize the adolescent nutrition screening questionnaire as part of their programs aimed at promoting healthy eating habits and addressing nutritional concerns among adolescents.
Note: It is important to consult with a healthcare professional if you have specific questions or concerns about your nutrition, as the questionnaire is a screening tool and should not replace personalized medical advice or care.
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What is adolescent nutrition screening questionnaire?
Adolescent nutrition screening questionnaire is a tool used to assess the dietary habits and nutritional status of adolescents.
Who is required to file adolescent nutrition screening questionnaire?
Healthcare professionals, such as pediatricians, dietitians, and nurses, are required to use and file adolescent nutrition screening questionnaire for their adolescent patients.
How to fill out adolescent nutrition screening questionnaire?
Healthcare professionals can fill out the adolescent nutrition screening questionnaire by asking the adolescent patient or their guardian questions about their dietary intake and habits.
What is the purpose of adolescent nutrition screening questionnaire?
The purpose of adolescent nutrition screening questionnaire is to identify any nutritional deficiencies or unhealthy eating patterns in adolescents in order to provide appropriate interventions and support.
What information must be reported on adolescent nutrition screening questionnaire?
Information such as daily food intake, food preferences, meal frequency, eating habits, and any potential nutritional concerns should be reported on the adolescent nutrition screening questionnaire.
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