We'd like you fill-up the Eating Habits Questionnaire for the patient. Shall we start?

Sure

Can we have your name, please?

Please enter the following information of the patient.

Patient name

Emergency contact number

Patient address

Please specify the types vegetables consumed by the patient.

Please specify the frequency of fruit intake in a day?

Do you take 3-4 ltr of water per day?

Is there anything you'd like to add?

Thank you for your feedback.