|
|
SECTION
FOR PROFESSIONALS IN THE TREATMENT OF OBESITY AND OTHER EATING DISORDERS
Professional Bariatric
History
Sample file to be used as
a guide for professional in the treatment of obesity.
Part (II)
| WAKING UP HOUR: |
|
| Time past between
waking hour and going to work: |
|
| GOING TO BED HOUR: |
|
| Time past between
going to bed and falling asleep: |
|
| TIME AND PLACE OF
BREAKFAST: |
|
| TIME AND PLACE OF
LUNCH: |
|
| TIME AND PLACE OF
DINNER: |
|
| ALCOHOL
BEVERAGES INTAKE: |
|
| WHICH: |
|
| QUANTITY: |
|
| TIMES PER WEEK: |
|
| SMOKING: |
|
| QUANTITY: |
|
| SMOKING SINCE: |
|
| EXERCISE: |
|
| WHICH: |
|
| HOW LONG: |
|
| TIMES PER WEEK: |
|
| EXCERCISING SINCE: |
|
| AMUSEMENT ACTIVITIES: |
|
| WHICH: |
|
| YOUR 5 FAVORITE MEALS: |
|
| 1 |
|
| 2 |
|
| 3 |
|
| 4 |
|
| 5 |
|
| FREQUENCY OF EATING
THEM: |
|
| 1 |
|
| 2 |
|
| 3 |
|
| 4 |
|
| 5 |
|
| 5 MEALS YOU DON'T EAT: |
|
| 1 |
|
| 2 |
|
| 3 |
|
| 4 |
|
| 5 |
|
| 5 MEALS YOU
DON'T LIKE TO EAT: |
|
| 1 |
|
| 2 |
|
| 3 |
|
| 4 |
|
| 5 |
|
| HAVE YOU BEEN ON A
DIET SOMETIME: |
|
| WHAT FOR: |
|
| WHAT TYPE: |
|
| HOW LONG: |
|
| RESULTS: |
|
| WHAT FOR: |
|
| WHAT TYPE: |
|
| HOW LONG: |
|
| RESULTS: |
|
| WHAT FOR: |
|
| WHAT TYPE: |
|
| HOW LONG: |
|
| RESULTS: |
|
| IS SOMEONE IN YOUR
FAMILY ON A DIET: |
|
| WHO: |
|
| WHY: |
|
| WHO: |
|
| WHY: |
|
| WHO PREPARES MEALS AT
HOME: |
|
| WHAT KIND OF
RESOURCES DO YOU HAVE TO EAT AT WORK: |
|
| DESCRIBE YOUR WEEKLY
EATING HABITS: |
|
| HOUR / PLACE |
|
| BREAKFAST |
|
| between: |
|
| LUNCH: |
|
| between: |
|
| DINNER: |
|
| after: |
|
| DESCRIBE YOUR WEEKEND
EATING HABITS: |
|
| HOUR / PLACE |
|
| BREAKFAST |
|
| between: |
|
| LUNCH: |
|
| between: |
|
| DINNER: |
|
| after: |
|
NEXT:
SAMPLE PROFESSIONAL FILE PART III

|
|
 Quote of the day:
|
|
Your opinion is very important to us
|
|
|
|
|
|
|
|
|
Follow our 18 tips for success in your diet
|
|