Professional Consultants

DONNA F. SMITH, C.C.N., C.N.
Licensed, Board Certified
Clinical Nutritionist

WILLIAM H. BRELAND, P.T., S.C.S.
Physical Therapist
Board Certified Sports Specialist

ROBERT J. WOLFF, D.C.
Chiropractor

T. ROGER HUMPHREY, M.D.
Physician

Advanced Clinical Nutrition
Wichita Falls, Tx
76309-3119
Office (940) 761-4045
Fax (940) 761-2881
E-Mail: wsnqas@aol.com


The information and services provided are for nutritional support, and not for the treatment of any medical condition or disease. By using this web site, you understand and abide by this disclaimer.

Copyright 1999
Donna F. Smith

Women Sports Nutrition Logo
Dietary Evaluation Overview (DEO)

PRINTING INSTRUCTIONS: Print before clicking SEND NOW button. Should this questionnaire not print entirely in Portrait format, simply click on the File menu, go to Print, click the "Properties" button. A new dialog box will open. On the "Paper" tab click the radio buttion labeled "Landscape", click ok to close the dialog box. Then click OK to print.
Date:
Name:
E-Mail:

WSN Acct. No.:


Advanced Clinical Nutrition, Wichita Falls, Tx 76309-3119
Office (940) 761-4045 Fax (940) 761-2881 E-Mail: wsnqas@aol.com

Copyright 1999 Donna F. Smith

Answer Key for Section I and II:
0 = Never
3 = Seldom/Special Occasions(Holiday Eating)
5 = Infrequent/Monthly
7 = Frequently/Weekly
10 = Daily

I. WHOLE / ALIVE FOODS:

1. Honey, Molasses, Maple Syrup, etc. 0 3 5 7 10
2. Whole Grains & their flours 0 3 5 7 10
3. Mono-unsaturated Oils (Canola, Olive, etc.) 0 3 5 7 10
4. Goat, Soy or Nut Milks & Cheeses 0 3 5 7 10
5. Turkey, Chicken, Fish 0 3 5 7 10
6. Fruit Juice, Natural Sodas, Sparkling Waters 0 3 5 7 10
7. Sea Salt, Veg-It, Mrs. Dash, Spike, Kelp 0 3 5 7 10
8. Fresh or Frozen Fruits (Frozen out of Season) 0 3 5 7 10
9. Fresh or Frozen Vegetables (Fresh in Season) 0 3 5 7 10
10. Raw unsalted nuts & seeds in shell 0 3 5 7 10
Your Score:

  
 II. CULTURAL / DEAD FOODS:

1. White, Brown, Artificial Sugars 0 3 5 7 10
2. White, Enriched Flour 0 3 5 7 10
3. Margarine, Artificial or Butter Substitutes 0 3 5 7 10
4. Cow Dairy Products (esp., Milk, Ice Cream) 0 3 5 7 10
5. Red Meats (no more than twice weekly) 0 3 5 7 10
6. Soda (Coke, Pepsi), Punch, Kool-aid 0 3 5 7 10
7. Table Salt, ex. Morton, Sodium Substitutes 0 3 5 7 10
8. Canned Fruits 0 3 5 7 10
9. Canned Vegetables 0 3 5 7 10
10. Salted nuts & salted seeds 0 3 5 7 10
Your Score:

OPTIMUM SCORES:
Non-Athlete: Section I = 90% or above - Section II = 10% or less
Athlete/Off Season: Section I = 90% or above - Section II = 10% or less
Athlete/In Season: Section I = 100% - Section II = 0%

If your score is less than indicated for optimum scores, click here to order your Clinical and Sports Nutrition Comprehensive Analysis and/or Dietary Analysis. Note: The Clinical and Sports Nutrition Analysis includes the Dietary Interpretation of your Food Chemistry

Copyright, 1999 Donna F. Smith