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Lifestyle Questionnaires

Please fill out the two forms on this page and hit submit at the bottom of each.

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The Real Deal logo - Online Weight Loss Program

Typical Day of Eating

Please list the time and all foods and beverages that you consume over the course of a typical day. Start from the first item consumed in the morning and list everything consumed over the next 24-hour period. It is important to be honest and specific when recording ALL of your food and beverages, including milk, coffee, etc.
Record one weekday and one weekend day.

You may find it easier to jot your days eating down on paper or your phone, then add into this form.

  • Weekday Meal

  • Please add the Time of Meal - Food/Beverages (all foods consumed) - the Amount Eaten (cups, oz., wt., etc.)- Food Preparation (grilled, sauteed, fried, etc.)
    Sample Day: 8:00am - 2 Eggs fried, 1 piece wheat toast, 1 tsp. butter, coffee (black), 6 oz. orange juice

  • Weekend Meal

  • Please add the Time of Meal - Food/Beverages (all foods consumed) - the Amount Eaten (cups, oz., wt., etc.)- Food Preparation (grilled, sauteed, fried, etc.)
    Sample Day: 8:00am - 2 Eggs fried, 1 piece wheat toast, 1 tsp. butter, coffee (black), 6 oz. orange juice