Form - Post Holiday HPQ Revisit Form

3 _ HPQ _ Post Holiday

Name
First Last
Date
Month
Day
Year

1. Identify 3 successes or more during the holidays vs. choices you've made in the past

2. Did you experience a difference in your relationship with food? (habits, urges, cravings, etc)
3. What old habits did you see creep back in? (primary foods, secondary foods)
4. What did you see/learn/observe about your feelings towards your environment and those people you spent the holiday season with?
Moving Forward..

1. What will you do differently next time: in secondary and primary foods?

2. List at least 2 things you know you can do (or have already done) to improve your DAILY NUTRITON this coming year

3. List at least 2 things you know you can do (or have already done) to improve your RELATIONSHIP WITH FOOD this coming year