Nutritionist Consultation Questionnaire

Nutritionist Consultation Questionnaire

Are you unsure if you need to see a clinical nutritionist?
Full Name

First NameLast Name
Date

MonthDayYear
Date
Please answer the following questions as honestly as possible. Circle the answer that best describes your position.
How often do you feel tired or fatigued during the day?
How would you rate your current eating habits?
Do you have any chronic health conditions (e.g diabetes, hypertension, IBS, POTs)?
How often do you experience digestive issues? (e.g bloating, constipation, pain)?
Are you currently taking any medications or supplements?
In the past 3 years, how many courses of antibiotics have you been on?
How many caffeinated beverages do you consume a day?
How often do you make eating decisions you regret?
How would you rate your sleep quality?
How often do you eat out or consume processed foods?
Do you struggle with maintaining a healthy weight?
How often do you feel stressed or anxious about your health or diet?
Do you have specific health or wellness goals you are trying to achieve?
How confident are you in your knowledge of nutrition and healthy eating?
How often do you skip meals?
How well do you understand portion sizes and their impact on your diet?
How often do you read nutrition labels when purchasing food?
How often do you try new healthy recipes or foods?
How do you feel about your current level of physical activity?
Do you drink alcohol?
How often do you drink 2-3 L of water a day?
(Female) Do you experience pain or symptoms with your menstrual cycle?
Are you or your partner trying to conceive ad are unsure of your dietary needs?
Do you experience any other symptoms?
Mostly A's: You seem to have a good handle on your nutrition and health. a consultation might still be beneficial for fine-tuning your habits or addressing specific concerns.

Mostly B's: You have some healthy habits but might benefit from professional advice to optimize your diet and address occasional issues.

Mostly C's: You could benefit significantly from seeing a nutritionist to help manage your health more effectively and address frequent concerns.

Mostly D's: It sounds like you would greatly benefit from professional nutritional guidance to help you manage your health, diet and any chronic conditions.

If you answered mostly, B's, C's or D's, consider booking a consultation with our nutritionist to discuss your health and dietary needs in more detail.
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