Linda Beeker, MS, RDN
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MRT Food Frequency Questionnaire


This form assists me in designing your LEAP protocol.  It is important that your phase 1 begins with foods that you are currently eating on a regular basis. 
INSTRUCTIONS:
  1. Score foods based on your experience over the PAST MONTH using the Scale of Frequency.
  2. If you do not eat a food or almost never eat a food, you can leave that field empty.
  3. Mark suspected adverse food reactions with an X and provide more information in the comments.
Scale of Frequency
0 = DO NOT eat a food or almost never eat a food
1 = RARELY (1 or less times per week)
2 = OCCASIONALLY (2 or 3 times per week)
3 = FREQUENTLY (4 or more times per week)
4 = DAILY

Adverse Food Reactions
X = Please mark all foods that you know or strongly suspect cause symptoms in any part of your body.  This includes symptoms caused by disease states, food allergies, food sensitivities, and food intolerance, (such as Celiac's disease and lactose intolerance).


    Your Unique2U Code is used to protect your privacy and is given to you in your Welcome Email. If you have misplaced your code, I will be happy to give it to you again.

    Beans & Legumes

    0 = Do Not           1 = Rarely            2 = Occasionally           3 = Frequently           4 = Daily          X = Adverse Food Reactions

    Meat & Poultry

    0 = Do Not           1 = Rarely            2 = Occasionally           3 = Frequently           4 = Daily          X = Adverse Food Reactions 

    Seafood

    0 = Do Not           1 = Rarely            2 = Occasionally           3 = Frequently           4 = Daily          X = Adverse Food Reactions  

    Nuts & Seeds

     0 = Do Not           1 = Rarely            2 = Occasionally           3 = Frequently           4 = Daily          X = Adverse Food Reactions 

    Dairy

    0 = Do Not           1 = Rarely            2 = Occasionally           3 = Frequently           4 = Daily          X = Adverse Food Reactions  

    Vegetables

    0 = Do Not           1 = Rarely            2 = Occasionally           3 = Frequently           4 = Daily          X = Adverse Food Reactions   

    Fruit

     0 = Do Not           1 = Rarely            2 = Occasionally           3 = Frequently           4 = Daily          X = Adverse Food Reactions   

    Grains

     0 = Do Not           1 = Rarely            2 = Occasionally           3 = Frequently           4 = Daily          X = Adverse Food Reactions 

    Flavor Enhancers & Miscellaneous

    0 = Do Not           1 = Rarely            2 = Occasionally           3 = Frequently           4 = Daily          X = Adverse Food Reactions  
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​Linda Beeker, MS, RDN

​~ All materials provided are for informational and educational purposes only.  Please consult a physician with respect to all medical conditions.
© COPYRIGHT 2016 - 2020 Linda Beeker. ALL RIGHTS RESERVED.
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