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Nutrition Guide

Please complete this form so I can create a nutrition guide based on your goals, preferences, and lifestyle. This is general nutrition guidance and is not medical nutrition therapy.

About You

Full Name

*

Email Address

*

Phone Number

*

Preferred Contact Method

*

A

Email

B

Phone Number

C

Both

Once payment has been processed, you will have access to contact me via SMS and e-mail during my business hours.

Age

*

Height

*

Current Weight

*

Goal Weight

*

Nutrition Goals

What is your primary nutrition goal?

*

A

Fat Loss

B

Muscle Gain

C

Body Recomposition

D

Maintain Weight

E

Improve Eating Habits

F

Increase Energy

G

Other

What would you most like help with?

*

Portion Control

Meal Ideas

Protein Intake

Grocery Shopping

Meal Prep

Eating Out

Consistency

Other

Current Eating Habits

How many meals do you usually eat per day?

*

Do you normally eat breakfast?

*

A

Yes

B

No

How often do you eat out or order food?

*

How much water do you drink daily?

*

Describe a typical day of eating.

*

Food Preferences

List foods you enjoy.

*

List foods you dislike.

*

Do you have any food allergies or intolerances?

*

Do you follow a specific diet?

*

No

Vegetarian

Vegan

Pescatarian

Halal

Gluten-Free

Dairy-Free

Other

Are there any foods you do not eat for personal, cultural, or religious reasons?

*

Lifestyle

What is your occupation?

*

How active are you during the day?

*

A

Mostly Seated

B

Lightly Active

C

Moderately Active

D

Very Active

How often do you cook at home?

*

How much time can you realistically spend preparing meals?

*

What is your approximate weekly grocery budget?

*

Health

Do you have any medical conditions, medications, digestive concerns, or history of disordered eating that may affect your nutrition?

*

Are you currently pregnant or breastfeeding?

*

A

Yes

B

No

C

N/A

Final

What is your biggest struggle with nutrition?

*

Is there anything else you would like me to know?

*