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FREE Diet Analysis

It's FREE! Get your diet program going in the right direction with Personal Dietitian's Free Diet & Nutrition Analysis. Your diet analysis will generate a personalized assessment of your needs. The output is designed and programmed by our expert's responses to a variety of diet and nutrition questions. The results are not complete and in no way should be viewed as a complete assessment but can help you understand some of the limitations of your current nutrition and/or diet regimen.

Learn how to improve your diet and overall health
Personal Dietitian's expert's give you a professional's viewpoint and the details you need to succeed. By joining any of Personal Dietitian's custom programs you can excel at your diet and/or health goals. With your plan you can "Do-it-Yourself" or get expert help as needed!

A Dietician's Diet About the Custom Diet and Nutritional Analysis
An overview of your diet and nutrition needs is given right away using the answers you give to this short quiz. The answers to the questionnaire below will be automatically e-mailed to our dietitian. The information from your profile will be held for you should you consider joining the Personal Dietitian Diet Program. Your profile is always kept confidential in our files and your information is never sold or used by anyone!

Personal Dietitian's FREE diet and nutrition analysis is courtesy of Carolyn Classick-Kohn, MS,RD

Get a diet that works...

	Entries with the letter (R) are required Personal Information
(R) Name
(R) Email

Subscribe to Personal Dietitian's FREE Diet Tips Newsletter?
Yes No

Physical Characteristics

(R) Gender	Male Female

(R) Height, in
(R) Weight	lbs
(R) Age

Exercise/Training...

1. Check one answer that best describes your level of physical activity
Competitive athlete
Physically fit, non athlete, regular exercise routine
Recreational activity ("week-end athlete")
Limited physical activity - gardening, walking, cleaning but does some movement of that type daily
Sedentary - not active or bare minimum for daily needs such at weekly chores.

A. Reduce body fatYes No

B. Lose weight Yes No

C. Improve nutrition ( health reasons, for competitive body building, gain weight, lose body fat, etc)
YesNo

D. Improve overall appearance ( competitive body builders, models, weight loss)
Yes No

E. Increase energy and overall fitness
Yes No

2. Additional Health Considerations:

1. Improve cardiovascular profile (Heart health-lower cholesterol, lower triglycerides-lower blood pressure)
Yes No

2. Heart Disease Yes No

3. High blood pressure Yes No

4 .High blood cholesterol YesNo

5. High triglycerides Yes No

6. Diabetes Yes No

7. Alcohol/substance abuseYesNo

8. Smoke tobaccoYes No

9. Taking prescription drugs regularly
Yes No

Women Only-
10. Pregnant
Yes No
11. Breastfeeding
Yes No

Diet and Nutrition

3. Primary Nutrition Goal
Improve Overall Nutrition

Lose Weight (lose fat and/or lose weight)

Gain Weight (increase lean body mass, decrease fat)

Maintain Weight (stay the same weight)

4. Special Needs (Choose any that apply):
Heart Healthy Diet (Diagnosed with Heart Disease, high cholesterol, etc)
Lower Sodium Diet (Diagnosed with High Blood Pressure, etc)
Lactose Free Diet
Dairy Free Diet
Vegetarian Diet
Vegan Diet
Diabetes
Other Special Need:

5.Nutrition
When you eat do you...
Eat mostly home-cooked meals (prepared from recipes or "scratch")
Eat about 1/2 home-cooked and 1/2 convenience or restaurant meals
Eat mostly convenience/packaged foods
Eat mostly fast foods or restaurant meals

Mark the answer that best describes the nutrition quality of your current diet:
It's nearly optimal
It's pretty good, but needs some fine-tuning
I eat mostly what I want and haven't worked on improving my diet

Current diet (Choose any that apply):
I take vitamin/mineral supplements
I use protein powder/protein drink supplements
I use energy boosters (caffeine, creatine, etc.)
I take herbal dietary supplements
I take weight loss pills, diuretics, carbohydrate blockers, or fat blockers

What kind of diet best defines your current eating style?
Typical Diet (high fat, high salt, restaurant foods, no diet changes yet)
Low fat, high protein
High fat, high protein
Low fat, average protein, high carbohydrate
High fat, low carbohydrate, moderate to high protein (low carb diet)
Mediterranean type diet
Other cultural diet (Asian, Middle Eastern, African, other)
Special diet (vegetarian, dairy free, allergy)
Medical needs diet
Not sure of diet composition

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