Weekly Food Summary

    Please fill in this summary once weekly and submit.
















    Do you eat after dinner?

    NoYes

    Are you eating more carbs such as pasta, rice, potato, bread?

    NoYes

    Are you eating more sweets?

    NoYes

    Did you increase fruit consumption?

    NoYes


    Note: The information entered on this page will be sent to Holistic Nutrition Services and to your email address entered above.