Thank you for your kind consideration in filling out this short 12 question survey!

The information you will be providing in this survey is the beginning of something BIG!  This is a beta study for a program that I've spent 5 years perfecting.   The program will either confirm your success in a diet that meets all nutritional goals OR help find nutritional gaps within that diet.   My mission is to help people identify these nutritional gaps and make dietary suggestions to maximize your nutritional goals and feel their best.  So please be as accurate as you can when you take this survey.  

Do your best to provide me with (3) days of the food you eat (including ALL sides) and the beverages you drink.  Be as specific as you can.  Instead of using words like "salad", use more specific words such as "salad with lettuce, tomato, onions, beets and shredded cheddar".

I wish I could properly express my appreciation for helping me launch something amazing!! For now, I'd like to extend a heart felt THANK YOU.

Question Title

* 1. First Name

Question Title

* 2. Last Name

Question Title

* 3. Email

Question Title

* 4. Age

Question Title

* 5. Gender

Question Title

* 6. Home zip code

Question Title

* 7. What do you typically eat for breakfast? (separate each food by a comma)

Question Title

* 8. What did you typically eat for lunch? (separate each food by a comma)

Question Title

* 9. What do you typically eat for dinner? (separate each food by a comma)

Question Title

* 10. What (if anything) do you typically eat in between meals each day? (separate each food by a comma)

Question Title

* 11. What beverages do you typically drink throughout the day? (separate each beverage by a comma)

Question Title

* 12. What (if anything) do you typically drink in between meals each day? (separate each beverage by a comma)

T