Consultation Questionnaire

1 Hour Consultation Questionnaire

Please complete these questions with as much detail as possible. During our consultation, be prepared to dive into your dieting history, health and wellness goals, current nutrition and fitness routine, and more. All consultations come with a PDF recap of our conversation which will include your custom macro calculations, my nutrition recommendations for you, nutrition topics, food lists, and more. I look forward to speaking with you!
Personal Information
First and Last Name*
Email Address*
Phone Number
Gender*
Preferred Pronouns
he/his, she/her, they/them
Age*
Height (inches)*
Weight (lbs)*
What is your occupation?*
Do you have any current injuries or medical conditions?
Goals and Challenges
What are your health and wellness goals?*

Lose weight/inchesIncrease lean massAthletic competition/event prepLifestyle changeCreate healthy food habits
Think about your ideal future self in 2 years. How do you feel? What do your days look like? What do you look like? What's important to you?*
What is your biggest nutritional challenge?*

Dislike cooking or don't know how to cookDon't know what I should eatWine/alcoholTime to prepare mealsLarge portionsEating out frequentlySweet toothEating quicklySnacking when not hungryCravingsLack of planningEmotional/stress eatingFamily or peer pressureOther
Activity
How many hours do you sit during the day?*
How many steps do you take per day?*

0-4,0004,000-6,0006,000-8,0008,000-10,00010,000+Not sure
How many hours of cardio do you complete per week? What type of cardio?*
How many hours of strength training do you complete per week? What type of strength training?*
Nutrition and Routine
Have you tracked your food or macros before?*
If you currently track your macros or calories, what are your current macro or calorie targets?
Are you vegetarian or vegan?*
Do you have any food intolerances, allergies, or special preferences?*
Ex. gluten free, preference for no red meat, etc.
Please describe your current nutrition regimen. Be brutally honest with what you're doing currently - not where you hope to be. No judgement here!*
What tactics have you tried in the past to improve your nutrition? What has worked? What didn't?*
Have you dieted for weight loss in the last 2 years? If yes, what diets? How many calories were you eating? How long did that last? Please be as detailed as possible.
Have you ever been diagnosed with an eating disorder or struggled with an undiagnosed eating disorder?
Do you currently:*

Meal PrepMeal PlanUse Meal Prep ServiceWing it
Describe your meal prep and/or meal planning:
How many times per week do you drink alcohol?*

0-11-22-34+I don't drink alcohol
How many times per week do you have fast food, dine out, or order takeout?*

0-11-22-34+
Stress Management
Do you have daily or weekly self-time dedicated to just you?*

YesNo
What things in your life make you happy? What activities charge your battery?*
LET'S GO!
What do you hope to leave this consultation with?*
Is there anything else you'd like me to know? What specific questions do you have for me?*
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1:1 Nutrition Consultation1-Hour Consultation, Macro Calculation, Recap PDF
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1 Hour Consultation Questionnaire

Personal Information

Goals and Challenges

Activity

Nutrition and Routine

Stress Management

LET'S GO!