Whatsup First Evatulation Form

Tell me a little about you

Your eating habits play a crucial role in achieving your desired outcomes. That's why you are requested to kindly share the details below to guide the creation of your personalized food and lifestyle protocol that will align with your taste preferences and goals, ultimately leading you to successful healthier version of yourself.

All the information is private and will not be shared with third parties or anyone unless requested by you via email at:
contact@buenoseeds.com

First Name

Last Name

Birthday

Today's date

What brought you to BuenoSeeds Nutrition?

Have you tried doing a nutrition program before? Tell a bit why it did not work for you.

Do you see yourself as an emotional eater? If yes, what are the emotions you feel that makes you want to eat?

In my daily eating practices I... (pick the options that is in your reality in this moment of your life. - There is no wrong answer.)

I consume one portion of fried foods, or at least 3 times per week. This includes anything fried, including vegetables such as, cauliflower, onions, French fries, mushrooms...

I consume one portion of animal products such as milk, yogurt, butter, cheese and or processed meats such as ham, roast beef, chicken breast, smoked salmon or turkey cuts or at least 3 times per week.

I consume foods that comes from packages or at least 3 times per week. (If you are unwrapping, it is considered food from package, even though is soup/ veggies or frozen fruits)

I consume read meat or at least 2 - 3 times per week.

I consume chicken or at least 2 - 3 times per week.

I consume pork or at least 2 - 3 times per week. This includes bacon.

I consume fish or at least 2 - 3 times per week.

I consume eggs, or at least 2 - 3 times per week.

Every day eat at least one portion of... (choose the ones you eat daily)

Fruits

Raw veggies

Sautéed veggies

Baked veggies

Green Salads

Green mixed salads with other ingredient such as tomatoes, cucumbers or others...

Grains such as, quinoa, wild rice, millets, bulgur...

Legume such as, beans, lentils, chick peas, peanuts...

When it comes to breads....

I love it and eat it every day.

I eat it at least 3 times per week.

I eat it on weekends

I do not eat bread.

What about sweets? How often you have one sweet bite?

Do you snack during the day? If yes, how many times?

Once a day

Two times a day

Three or more times a day

No, I do not snack during the day.

Please list the foods you usually snack. If you don't snack, write 'I don't snack'.

What are your favorite foods? List all you love

What are your favorite food style? Italian, American, Asian... It can be more than one :)

What are the foods that you cannot stand? List all, including spices, flavors you don't like.

What time do you sleep?

What time is your last eating of the day?

If you are a woman that have period, what day of your cycle are you in today?

Do you often have yeast infection?

Yes

Nope

I don't know

Would you like to improve your hormones?

Yes

Nope

Perhaps

I don't know about my hormonal situation

If you know something about your hormonal situation, please share below:

What is your favorite meal of the day? Breakfast/ Lunch/ Afternoon Snack/ Dinner

If you are allergic, list the food/ ingredients/ spices here:

What do you want to take out of this program?

Re-learn foods benefits to keep my body balanced and not inflamed

Learn what foods to buy at the market

Learn how to prepare foods so I don't have to cook all the time

Learn how to cook foods so they don't lose their nutritional value and my body can absorb them better

Learn how to store foods properly so it is easier to manage my everyday routine

Be healthier and an example for my kids and other family members

I feel my health is affected by my food choices and lifestyle and I want to get better

Learn to eat when traveling

Learn to eat when out for dinner & parties

Let' talk about your daily water intake

I drink 2-4 full glasses of water

I drink 4-8 full glasses of water

I drink 8-10 full glasses of water

I drink 12 + full glasses of water

From the moment you wake up, what do you do? List your routine using numbers to show me what are the sequences of moves you make in the morning: (1) OPEN MY CELPHONE TO CHECK (2) GO TO THE BATHROOM (3) BRUSH MY TEETH (4)DRINK WATER (5) START MY ERRANDS RIGHT AWAY AND TAKE CARE OF ME LATTER (6) DRINK TEA OR COFFEE (7) TAKE SUPLEMENTS (8) EAT BREAKFAST (9) MEDITATE (10) EXERCISE

Do you work out? If yes, how many times per week? What kind of work out? How long each session?

Do you go to the bathroom every day? If the answer is 'no', how many times per week do you go? How is the consistance?

Any other routine you want to share that was not listed? Please write below

Do you have any medical condition? If yes, please explain what is it and if you are taking any medicine, please list the medicine.

Are you taking any supplementation? If yes, please write their name and brand bellow, if you are not, just write 'No'.

Enter your full name here. It represents you do agree with the previous message.

Do you know your weight? If the answer is yes, please write it bellow.

Do you know your height? If yes, please write it bellow.

Are you familiar with subconscious, unconscious and conscious mind? If so, please explain the difference. This will help me understand how we can work your eating habits towards sucess of you achiving the results you desire with anti-inflammator nutrition.

I agree to the terms & conditions

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Now that you filled it all out, this what happens next:

Dr. Gabriela said:

Amazing Wellness Challenge!

I was skeptical as I embarked in the 31 day wellness challenge given that I already felt knowledgeable in how to make healthy food choices but I was amazed at how much I learned during my 31 days of plant-base eating. There are so many protein alternatives to meant and animal products that I never missed eating meat. Most surprisingly I find myself not wanting to eat as much chicken anymore and have rediscovered a love of chickpeas instead! I would recommend working with Ana and learning how food can be both delicious and healing at the same time! Food truly is medicine and while eating a plant -based anti-inflammatory diet I felt great and could work out harder? I will definitely maintain some of the habits I developed such as eating cheese as an indulgence and incorporating more dairy-free yogurt on my breakfast menu.

Dr. Gabriela Velez
Kidney Associates of Colorado

Tell me a little about you

Dr. Gabriela said:

Start Transforming Yourself