Describe your current stress level
High, lots of stress, under pressure
Average, mild stress, some pressure
Low, little stress, no pressure
Describe your sleep pattern
Sleep soundly, refreshed upon waking
Wake up throughout the night, unrefreshed in morning
Poor, unrefreshing, find it hard to get to sleep
Describe your energy levels
Good, plenty of energy
Average, feel tired sometimes
Please tick any foods and drinks you consume on a regular basis
Sugar, cakes, chocolate
White bread, rice, pasta
Wholemeal bread, brown rice, pasta
Red meat eg beef, lamb, ham
Poultry eg chicken, turkey
Fish eg salmon, tuna
Non-meat alternatives eg tofu, soya
Dairy products eg milk, cheese
Goat's/sheep's products eg cheese, milk
Yoghurt
Snack foods eg crisps, peanuts
Nuts and seeds eg almonds, pumpkin seeds
Fruit eg fresh, frozen, tinned, dried, smoothies
Vegetables eg fresh, frozen, tinned
Salt
Caffeine drinks eg tea, coffee, fizzy drinks
Herbal/fruit teas eg green tea, lemon
Non-dairy drinks eg rice, soya milk
Water
Describe your diet
Good, eat healthy, 5 or more portions of fruit and veg
Average, eat healthy, a few portions of fruit and veg, still have treats
Poor, eat junk food, hardly any fruit and veg
Do you smoke?
Yes