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.
- Score foods based on your experience over the PAST MONTH using the Scale of Frequency.
- If you do not eat a food or almost never eat a food, you can leave that field empty.
- 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).