Primal Pattern Diet

NOTE: Please only fill this form out after you've spoken to DannyTheCoach.
This questionnaire is designed to help us determine the optimal macro-nutrient ratio (fats vs. proteins vs carbohydrates) to begin the process of fine-tuning your body's feedback mechanisms.

When answering the questions, check the answer that best describes the way you feel, not the way you think you should eat!
If none of the answers apply, simply don't answer the question.
If answer A suits you some of the time (maybe in the morning but not in the evening), and answer B suits you other times, check both answers provided that the answers refer to how you may feel on any given day, not within a period of over 24 hours!

DEMOGRAPHIC DATA

QUESTIONS - Please answer all* questions.

1. I sleep best: *

A. When I eat a snack high in protein & fat 1 - 2 hours before going to sleep B. When I eat a snack higher in carbohydrates 3 - 4 hours before going to sleep

2. I sleep best IF: *

A. My dinner is composed of mainly meat with some veggies or other carbs B. My dinner is composed mainly of veggies or other carbs and a comparatively small serving of meat

3. I sleep best and wake up feeling rested: *

A. If I don't eat sweet deserts like cakes, candy or cookies. I'm ok with rich deserts that are not overly sweet (high-quality full-fat ice cream) B. If I occasionally eat a sweet desert before I go to bed

4. After vigorous exercise, I feel best when I consume: *

A. Foods or Drinks with higher protein and/or fat content (high-protein shake) B. Foods or Drinks higher in carbohydrates (sweeter, such as Gatorade)

5. I do best - maintain mental clarity & a sense of well-being for up to 4 hours after a meal - when I eat: *

A. A meat-based meal containing heavier meats such as chicken legs, roast beef & salmon, with a smaller portion of carbohydrates B. A carbohydrate-based meal containing veggies, bread or rice & a small portion of a lighter meat such as chicken breast or white fish

6. If I'm tired & consume sugar or sweet foods (donuts, candy, sweetened drinks) without significant amounts of fat or protein: *

A. I get a rush of energy, but then I'm likely to crash & feel sluggish B. I feel better & my energy levels are restored until my next meal

7. Which statement best describes your disposition toward food in general: *

A. I love food & live to eat B. I do not fuss over food & I eat to live

9. Instinctually, I prefer to eat: *

A. Dark meat, such as chicken or turkey legs & thighs over white breast meat B. Light meat such as chicken or turkey breast over dark leg & thigh meat

10. Which list of fish most appeals to you? *

A. Anchovy, caviar, herring, mussels, sardines, abalone, clams, crab, crayfish, lobster, mackerel, octopus, oyster, salmon, scallops, shripm, snail, squid, dark meat tuna B. White fish, catfish, cod, flounder, haddock, perch, scrod, sole, trout, white meat tuna, turbot

11. When eating dairy products, I feel best after eating: *

A. Richer, full fat yogurts & cheeses or desserts B. Lighter, low fat yogurts & cheeses or desserts

12. With regard to snacking: *

A. I tend to do better when I snack between meals or eat more smaller meals throughout the day B. I tend to last between meals without snacking

13. Which describes the way you instinctively prefer to start your day in order to feel your best & to have the most energy? *

A. A large breakfast that includes protein & fat, such as eggs with sausage or bacon B. A light breakfast such as cereal, fruit, yogurt, breads & possibly some eggs

14. Which characteristics best describes you: *

A. In general, I digest food well. Have an appetite for protein, feel good when eating fats or fatty foods. I'm more muscular or inclined to gain muscle or strength easily B. I'm more lithe of build. Prefer light meats & lower fat foods. I'm more inclined toward endurance athletics

Primal Pattern Diet

CONFIDENTIALITY NOTICE: ALL OF YOUR INFORMATION IS SECURED, CONFIDENTIAL AND WILL NEVER BE SHARED WITH ANYBODY. This data helps DannyTheCoach to formulate a plan of action.

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