2. First Name
3. Last Name
5. HH or ID#*
6. Date and Time of Appointment*
   Date and Time of Appointment

   Date and Time of Appointment
7. Phone
9. Whole Grain Video Questions
11. 1. What should you look for on the label of grain products?*

    1. a. Wheat
    2. b. 100% Whole Grain
    3. c. Whole grain as the first ingredient
    4. d. B and C
12. 2. How can you include whole grains in your meals?
14. 3. What is the number of servings a day needed for adults/children?*

    1. a. Adults 10; Children 5
    2. b. Adults 6-8; Children 6-8
    3. c. Adults 6-8; Children 3-5
    4. d. Adults 3-5; Children 6-8
16. 4. Which is NOT equal to one serving of whole grain?*

    1. a. 1/2 cup whole grain pasta
    2. b. 1 whole grain tortilla
    3. c. 2 slices whole grain bread
    4. d. 1/2 cup brown/whole grain rice
17. 5. What percentage of daily grains should be whole grains?*

    1. a. 25%
    2. b. 100%
    3. c. 30%
    4. d. 50%
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