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Clients and Patients -> Therapeutic Kitchen's Metabolic Management (TKMM): Dietary Assessment and Wellness Planning

Therapeutic Kitchen's Metabolic Management (TKMM): Dietary Assessment and Wellness Planning

NAME:____________________;
DATE:__________;

I. Current Dietary Intake
Instructions: In the space provided for each item, place the number that corresponds best to the number of times that you consume the item each week.

“0” = none
“1” = 1-2 times / week
“2” = 3-4 times / week
“3” = 5-7 times / week

A. Protein / Nuts: almonds _____ / walnuts _____ / pine _____ / chestnut___ / tempeh ____ / seitan ____ / tofu___ / vegetable protein ___ / lentils ____ / aduki beans ____ / pinto beans ____ / great northern ____ / garbanzo ___ / black turtle beans ___ / red meat ___ / fish __ / poultry ___ / Soy ___ / Egg ___ /

B. Whole / Cracked grains: brown rice __ / barley __ / quinoa __ / cereals __ / Millet __ / white rice __ / couscous __ / cream of rice or cream of wheat __ / oatmeal __ /

C. Raw vegetable juices: celery ____ / dandelion ____ / wheatgrass ___ / Carrot ____ / spinach ___ / cucumber ___ / beet ___ / parsley ___ / turnip ___ /

D. Raw / Steamed / Sea / Root vegetables: asparagus ___ / cauliflower __ / kale ___ / broccoli ___ / collard ____ / bok choy / cabbage ___ / garlic ____ / sea palm ___ / kelp ___ / kuzu ___ / yams/sweet potato/squash ___ / onion ___ / arame ___ / wakame ___ / kombu ___ / dulse __ / nori __ / hijiki ___ / ginger ____ /

E. Seeds/Oils: sesame __ / flax __ / sunflower __ / olive __ / pumpkin __ / linseed __ /

F. Fruit: sweet ____ / sub-acid ____ / acid ____ / melons ____ / || Brewers yeast __ /

G. Sprouts: alfalfa ____ / sunflower ____ / buckwheat ____ / red clover ___ /
II. Other Detoxification Methods for Healing:
A. Shower ____ /Bath ____ / Skin Brushing ______ /
B. Daily water intake: 20 oz or less ____ / 20-40 oz ____ / 40-60 oz ____ / 60-80 oz ____ /
C. Coffee / herbal enemas / other colon hygiene: _________;
D. Trampoline exercises (10-40 minutes/day as tolerated) ______ /
E. Yoga / Tai Chi (20 - 40 minutes as tolerated) ______ /
F. Walking _____ / Jogging _____ / Golf _____ / Tennis _____ / Swimming ____ /
III. Energetic/Emotional/Spiritual Exercises for Healing:
A. Course in Miracles, daily lessons _____ /
B. Prayer / Mindfulness / Meditation (30 - 40 minutes) _____ /
C. Affirmations with Flower Essences _________ /
D. 28 Day Plan for Uncovering the Ideal Self _____ /
E. Guided Imagery / Visualization:_________________ /
F. Sound / Music / Aromatherapy _____ /


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