Nutrition Consultation
Raleigh Patrick Fitness & Nutrition
Date
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Month
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Day
Year
Date
Name
First Name
Last Name
Email
example@example.com
Weight
Height
Age (years)
My main goals are focused around
Weightloss
Muscle gain
Strength gain
Athletic performance
Other
What is your natural body type?
Ectomorph - More narrow shoulders and hips in respect to height.Relatively smaller muscles in respect to bone length.Naturally fast metabolism makes it difficult for many to gain mass.
Mesomorph - Medium bone structure with shoulders wider than the hips.Developed athletic musculature.Efficient metabolism; mass gain and loss both happen with relative ease.
Endomorph - Stockier bone structures with larger midsection and hips. Carries more fat throughout the body. Gains fat fast and loses it slow.
What is your level of physical activity?
Level 1 - Sedentary: Being almost completely inactive throughout the week.
Level 2 - Some physical activity, Non-vigorous activity during at least 4 hrs/week. Examples: walking, leisure gardening
Level 3 - Moderate Physical Activity, Regular physical activity and training 2-3 hrs/week of moderate activity such as running, swimming, biking, tennis.
Level 4 – VigorousActivity, Regular hard physical training forcompetition sports several timesper week. Examples: running,skiing, soccer, etc. several timesper week.
List your specific goals from 1-3 in importance
Have you tried any diets or diet programs in the past? If yes, list below.
What do you eat and drink on a regular basis?
Do you have any food allergies or intolerances? If yes, list below.
Do you take any supplements or vitamins? If yes, list below.
What are some of your favorite foods and beverages?
Do you have any concerns with your current eating habits? If yes, explain below.
Do you have any barriers to healthy eating, or changing your eating behavior? If yes, explain below.
Main takeaways and action points from this session to implement.
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