What is your activity level? @error('activity_level[]') {{ $message }} @enderror

Any other activities? (How Often) @error('activities') {{ $message }} @enderror

Food Preference @error('food_preference[]') {{ $message }} @enderror

Are you pregnant or breastfeeding? *

pregnant_breastfeeding) && $row->pregnant_breastfeeding == 'yes') checked @endif required> Yes pregnant_breastfeeding) && $row->pregnant_breastfeeding == 'no') checked @endif required> No

@error('pregnant_breastfeeding') {{ $message }} @enderror

Are you under the age of 16 years old (0-15 years old)? *

under_age) && $row->under_age == 'yes') checked @endif required> Yes under_age) && $row->under_age == 'no') checked @endif required> No

@error('under_age') {{ $message }} @enderror

Have you been medically diagnosed with any eating disorder (i.e. anorexia nervosa, anorexia bulimia, binge eating disorder)? If yes, please indicate below: *

medically_diagnosed) && $row->medically_diagnosed == 'yes') checked @endif required> Yes medically_diagnosed) && $row->medically_diagnosed == 'no') checked @endif required> No

@error('medically_diagnosed') {{ $message }} @enderror

Have you been diagnosed with diabetes mellitus (i.e. pre-diabetes, type I, type II & gestational diabetes)? If yes, please indicate below: *

diabetes_diagnosed) && $row->diabetes_diagnosed == 'yes') checked @endif required> Yes diabetes_diagnosed) && $row->diabetes_diagnosed == 'no') checked @endif required> No

@error('diabetes_diagnosed') {{ $message }} @enderror

Have you been diagnosed with coeliac disease? *

coeliac_diagnosed) && $row->coeliac_diagnosed == 'yes') checked @endif required> Yes coeliac_diagnosed) && $row->coeliac_diagnosed == 'no') checked @endif required> No

@error('coeliac_diagnosed') {{ $message }} @enderror

Have you been diagnosed with cancer? *

cancer_diagnosed) && $row->cancer_diagnosed == 'yes') checked @endif required> Yes cancer_diagnosed) && $row->cancer_diagnosed == 'no') checked @endif required> No

@error('cancer_diagnosed') {{ $message }} @enderror

Have you been diagnosed with renal disease? *

renal_diagnosed) && $row->renal_diagnosed == 'yes') checked @endif required> Yes renal_diagnosed) && $row->renal_diagnosed == 'no') checked @endif required> No

@error('renal_diagnosed') {{ $message }} @enderror

Have you ever had bariatric surgery (i.e. gastric sleeve, gastric bypass, lap-band)? If yes, please indicate below: *

bariatric_surgery) && $row->bariatric_surgery == 'yes') checked @endif required> Yes bariatric_surgery) && $row->bariatric_surgery == 'no') checked @endif required> No

@error('bariatric_surgery') {{ $message }} @enderror

Have you been diagnosed with any of the following gastrointestinal tract issues? Diverticulitis, bowel obstructions and bowel resections, irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) including ulcerative colitis and/or Crohn's disease. If yes, please indicate below: *

issues_diagnosed) && $row->issues_diagnosed == 'yes') checked @endif required> Yes issues_diagnosed) && $row->issues_diagnosed == 'no') checked @endif required> No

@error('issues_diagnosed') {{ $message }} @enderror

Have you been diagnosed with thyroid disease (i.e. hypothyroidism or hyperthyroidism)? If yes, please indicate below: *

thyroid_diagnosed) && $row->thyroid_diagnosed == 'yes') checked @endif required> Yes thyroid_diagnosed) && $row->thyroid_diagnosed == 'no') checked @endif required> No

@error('thyroid_diagnosed') {{ $message }} @enderror

Are you currently taking any prescribed medication for blood pressure, cardiovascular disease or high cholesterol, such as ACE inhibitors, beta blockers, warfarin, or statins? If yes, please list the medication(s) below and provide a reason for taking the medication(s): *

medication_prescribed) && $row->medication_prescribed == 'yes') checked @endif required> Yes medication_prescribed) && $row->medication_prescribed == 'no') checked @endif required> No

@error('medication_prescribed') {{ $message }} @enderror

SANDY

Nutritional Advisor Form

Risk stratification screening tool (RSST)