Total Diet Recall Questionnaire

Total Diet Recall QuestionnairePart I. Food   (circle yes or no)Finish the sentence, I eat:Fruits and vegetables every day                  Yes   NoSweets less than twice a week                    Yes   NoBreakfast daily                                  Yes   NoFish at least twice times week                   Yes   NoWhole grains at least five times a week          Yes   NoSoy foods (tofu and soybeans) twice a week       Yes   NoRed meat less than twice a week                  Yes   NoOrganic foods every day                          Yes   NoBeans and legumes at least five times a week     Yes   NoA handful of nuts every day                      Yes   No Part II. Beverages (circle yes or no)Finish the sentence, I drink:Water throughout the day                         Yes   NoPlain coffee every day (no more than 3 8-ounce   Yes   Nocups)A glass of fruit juice every day (1 glass =      Yes   No4 oz.)Not more than 1 to 2 glasses of alcohol daily    Yes   NoMilk shakes occasionally                         Yes   NoRegular soda less than twice a week              Yes   NoMineral water daily                              Yes   NoFruit shakes at least three times a week         Yes   NoGreen tea daily                                  Yes   NoDiet soda less than once per day                 Yes   No Total Diet Score Card                            ____  ____Tally your score by counting up the number of yes's and no's. If you have more yes's, you have a balanced diet filled with real, whole foods and make room for small indulgences. If you have more no's, you should evaluate your overall diet and try to incorporate more nutrient-rich foods into your day.Courtesy of The Essential Guide to Healthy Healing Foods by Victoria Shanta Retelny, RD, LDN.Total Diet Recall Questionnaire_VSR