The Diet Angel

PayPal receipt number

Name of person receiving report

Email address to send report to

Birth date

Height

Weight

How active are you in your leisure time?
Not very active
Moderately active
Very active

How active are you at work?
Not very active
Moderately active
Very active
Not working

If you've eaten meat, did you cut off the visible fat? Or taken off the skin on poultry?
No
Yes

If you've eaten fish, was it in batter?
No
Yes

If your fish was in batter, what kind of oil was it fried in?

Which spread or butter do you use?

If you've eaten tinned fish, was it in brine or oil?
Brine
Oil

Do you use low or reduced sugar foods or drinks?
Yes
No

Do you use low or reduced salt foods or drinks?
Yes
No

Do you use low or reduced calorie foods or drinks?
Yes
No

If you've had a jacket potato, did you eat the skin?
Yes
No

If you've had a vegetarian meal, did it contain quorn?
Yes
No

If you've eaten tinned fruit, was it in syrup or juice?
Syrup
Juice

What did you eat at breakfast?

What did you drink at breakfast?

What did you eat mid-morning?

What did you drink mid-morning?

What did you eat at lunchtime?

What did you drink at lunchtime?

What did you eat mid-afternoon?

What did you drink mid-afternoon?

What did you eat at your evening meal?

What did you drink at your evening meal?

What did you eat after your evening meal?

What did you drink after your evening meal?

What other food, drink or snacks have you eaten today?

Now, please check that you've not missed anything and press submit below!