Conquer Your Cravings and Regain Control of Your Diet
Name
Email
How old are you?
Under 18
18-24
25-34
35-44
45-54
55-64
65 or over
What type of food do you crave the most?
Salty (i.e.: potato chips, french fries, crackers)
Sweet (i.e.: pastries, chocolate, sugary cereal)
Fried (i.e.: french fries, fried chicken)
Dairy (i.e.: milk, cheese, ice cream)
Starchy (i.e.: potatoes, bread)
Other:
What time of day do your cravings strike?
Morning
Afternoon
Night-time
Morning
When in your menstrual cycle do you experience cravings?
During menstruation (Days 1-7)
Mid-Cycle/Ovulation (Days 10-16)
End of Cycle (Days 21-28)
Other:
What is your biggest concern regarding cravings?
For example: Do you worry about chronic diseases, weight gain, binge eating, mood swings, hormonal balance or other reasons connected to your cravings?
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