Dairy Council of CA - Activities - Personal Nutrition Planner

Dairy Council of California



	Please enter the following information. You must enter the information in the required fields, indicated by an asterisk, in order for the program to provide an assessment of your calorie and nutrient needs. Entering incomplete information may result in inaccurate recommendations. All feilds with "" are required.











		feet inches


		(If you are pregnant, enter your pre-pregnant weight.)



		Extremely Active			Very Active
		(exercise vigorously at least 7 times/week for > 60 min)			(exercise at least 5-7 times/week for 30-60 min per session)

		Moderately Active			Sedentary
		(exercise 2-5 times/week for 30-60 min per session or have an .active job)			(do not exercise on a regular basis)



	Select if you think you need to:


		Lose Weight			Gain Weight

		Maintain Your Weight

Select all of the diseases listed below for which you think you are at risk. If you already have one of these diseases ask your health care provider for specific nutritional guidance.


	Osteoporosis				Hypertension

	Heart Disease				Type 2 Diabetes

	Cancer - General				Breast Cancer

	Colon Cancer				Over Weight

Select if you:


	Are Pregnant				Are Lactating

	Are Overweight				Have Lactose Intolerance

	Have Asthma				Have Food allergies


	Yes			No
	(includes ovo-lacto vegetarians)



		Frequent			Moderate
		(daily multivitamin + other specific nutrient supplements)			(multi-vitamin most days)

		None			Herbal Supplements
		(no supplements or occasional multi-vitamin)

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