1.Typical daily food intake?

 Are you fond of eating fast food foods,chips or processed foods, spicy foods?
 Are you eating vegetables and fruits regularly?
 Are you taking food Supplements (vitamins)

2. Typical daily fluid intake?

 Are you drinking water daily? IF YES? How many glass of water do you consume
daily?
 Are you drinking coffee or alcohol? IF YES? How many cup of coffee do you
consume?How many bottles of alcohol do you consume?

3. How is your appetite? Do you have loss of appetite?

4. Discomfort? Do you have pain or difficulty in eating and swallowing?
5. Are there foods that is not allowed for you eat? Or any food allergies?
6. Weight loss or gain? (Amount) Height loss or gain?