• Optimal Health Revolution

    NUTRITIONAL & HEALTH RISK ASSESSMENT SHEET
  • Gender
  • Marital Status
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  • Total Protein need calculation for a Day.

    ( Your body needs protein for nearly everything it does. Protein is needed to build and repair our muscles, to make our hair and skin, to fight against infections and to carry oxygen in our blood. Proteins are made up of building blocks called amino acids. There are about twenty different amino acids, and your body can actually make some of them. There are nine amino acids, however, that your body can't make. These are called essential amino acids(9) and the only way to get them is through the food you eat. It's important to eat a variety of protein foods every day to make sure your body gets all of the essential amino acids.)

  • Your Catagary
  • Rows
  • Rows
  • Rows
  • How many days you exercise in a week?
  • How often do you eat “fast” or convenience-style restaurant foods or meals?
  • Do you have allergies to, or prefer not to consume any of, the following ingredients? Check all that apply.
  • How many servings of fruits and vegetables to eat during an average day? (1 serving=1/2 cup raw or 1 cup boil) (Recommended 6-8 serving/day- W.H.O)
  • Do you eat colorful fruit and vegetable in your everyday diet?
  • Do you skip on breakfast and eat a heavy lunch and dinner in hope that you consume fewer calories?
  • Do you skip meals, often cut calories to lose weight, or follow a low-carbohydrate diet?
  • Do you have any health challenge in family history (siblings, parents, grandparents, aunts, or uncles) of any of the following (before Age 60):
  • Do you have currently any health challenge of the following: (Tick if have before 6 month)
  • Check all that apply:
  • How many times you smoke in a day ? (no. of cigarettes)
  • How many times you take tobacco(Gutkha) per day ? (no. of packets)
  • How many times you drink(Alcohol) in a week?
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  • How many glasses(200-250 ml) of water do you consume on an average day?
  • Are you ?
  • Which oil you are using for food ?
  • Are you eating enough salad with food and raw fruit and vegetable. [Fiber intake (25g-35g / day Recommended)] ?
  • Hormonal Disorder (Thyroid) ? prefer for female
  • Lifestyle Factors and Clinical Indicators of Vitamin and Mineral Deficiency. Tick if you have any health challenge written below !!
  • Drugs Causing Nutrient Depletion - Tick, if you are using drug currently or last 6 month or before 6 month ?
  • Symptoms of side effect in your body: (When take medicine)
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  • if Possible please send me your health checkup reports at our email-id :   wellnesscircleteam@gmail.com

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