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PLACE LABEL HERE NUTRITION QUESTIONNAIRE and AMBULATORY SUMMARY Please complete this form to help your Dietitian learn about you. ABOUT YOURSELF Name: Education/Last grade attended: Work hours: Date:
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How to fill out a nutrition questionnaire - Gwinnett:

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Start by carefully reading the instructions provided with the questionnaire. Make sure you understand the purpose and requirements of the questionnaire.
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Begin by providing your personal information, such as your name, age, address, and contact information. This will help the organization or individual conducting the questionnaire to identify and categorize your responses.
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Fill out the sections related to your dietary habits and preferences. This may include questions about your daily food intake, eating patterns, preferred cuisine, and any dietary restrictions or allergies you may have. Be honest and accurate in your responses to provide valuable information to the questionnaire provider.
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Nutrition questionnaire - Gwinnett is a form used to collect information about an individual's dietary habits and nutrition status.
All residents of Gwinnett County are required to file the nutrition questionnaire.
The nutrition questionnaire can be filled out online or submitted in person at the designated locations.
The purpose of the nutrition questionnaire is to gather data on the eating habits and nutritional needs of the residents of Gwinnett County.
Information such as food consumption patterns, dietary restrictions, and nutritional supplements must be reported on the nutrition questionnaire.
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