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Average # of Days/Week You Eat Out
Rate Current Support System
Rate Current Energy Levels:
Average Daily Caffeine (Cups) Intake
Average Alcohol Conumption/Week

Anwer the Following Statements (On Average):

I Eat Breakfast
I Eat a Mid-Morning Snack
I Eat Lunch
I Eat a Mid-Afternoon Snack
I Eat Dinner
I Eat Dessert
I Eat Less Than 2 Hours Before Bedtime

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