Marital status / Family situation Profession Do you have specific questions in the field of lifestyle and diet? specifieke_vragen_leefstijl_ja
If yes, what are your questions?
What do you think is the relationship between your symptoms and your lifestyle?
5. Are your symptoms periodically dependant?
Questions with regards to dietary habits How much do generally eat? What kind of food do you prefer? What do you eat very regularly? What do you usually eat? How many grams of (raw) vegetables do you usually eat? Do you regularly eat (unroasted) nuts and seeds? Which fats do you use for cooking and frying?
Do you often have extreme cravings for sweets? Do you add sugar? Do you add salt? Can you easily skip meals? If so, which meals do you skip? Do you often binge-eat? Do you often feel bloated after a meal? Are you allergic to any foods?
If yes or maybe, which:
Have you ever been on a diet?
If yes, which diet(s):
What kind of short-term results did this deliver?
How many maximum kg lost?
What kind of long-term results did this deliver?
How many kg lost or gained?
Do you have dietary restrictions? dieetrestricties_ja
If yes, which
Do you use vitamin/mineral supplements? supplementen_ja
If yes, which and how many?
Do you cook for others? kokenvooranderenhoevaak
If yes how many times per week?
What do you drink regularly? Do you drink coffee? If yes, how many cups per day? Do you drink alcoholic beverages? dranken_ja
If yes, which:
If yes, how many glasses per week?
Questions regarding health (-past): Do you have any major concerns about your health? zorgen_ja
If yes, about what?
Do you have health complaints? gezondheidsklachten_ja
If yes, which?
Do you smoke? roken_ja
If yes, how much?
Do you use medication or painkillers? medicijnen_ja
If yes, which?
Do you take soft/hard drugs? drugs_ja
If yes, which and how much?
Have you ever been prescribed an antibiotics course? antibiotica_ja
If yes, for which condition?
If yes, did you take a course of probiotics? mancos
What health deficiencies have manifested themselves over the years?
Have you undergone any operations? operaties_ja
If yes, which?
Have you ever been diagnosed with hypoglycaemia (low blood glucose)? Do you sweat a lot? Do you have skin concerns? Do you have any joint concerns or complaints? Do you have digestive issues? Do you have regular bowel movements? If no or sometimes, in what sense is this different? Is your bodyweight stable? How would you describe your blood pressure? Do you have any issues with your sleep? Do you wake up easily and feeling rested? hoeveeluur
How many hours, on average, do you sleep?
Do you experience stress?
On scale 1 – 10:
General questions regarding current fitness: How has your fitness been in the past few years? Do you feel that you have enough energy? How is your general feeling of wellbeing? How much time do you spend exercising per day? (walking, biking etc. in minutes) Do you exercise? sport_welke
If yes, what kind?
How many times per week
57. Goal: what do you hope to achieve with lifestyle coaching? Only for women: Are you in the menopause? If yes, since when? Do you have (or had) problems with your menstruations?
If yes, what kind of problems?