Nutrition Guide Questionnaire

Nutrition Guide Questionnaire
Client Information
Full Name

First NameLast Name
Date of Birth

MonthDayYear
Gender
Age
years
Height
ft/in
Current Weight
lbs
Goal Weight (If you have one)
What is the activity level at your job?
Lifestyle & Sleep
Do you have any diagnosed medical conditions? (e.g., diabetes, Hashimoto’s, high blood pressure):
Do you take any medications or supplements regularly?
How many hours do you sleep per night?
Do you feel rested when you wake up? (Yes/No):
Training & Activity
How many days per week do you resistance train?
How many days per week do you practice cardio or mobility?
What are your primary fitness goals? (e.g., fat loss, strength, endurance, performance)
Do you play any sports or engage in recreational activities?
Nutrition & Preferences
Do you have any dietary restrictions or allergies? (e.g., dairy-free, gluten-free)
Please list:
Have you practiced calorie restriction to lose weight in the last 90 days?
Preferred sources of protein: (e.g., chicken, fish, tofu, whey)
Preferred sources of carbohydrates: (e.g., rice, potatoes, fruit)
Preferred sources of fat: (e.g., avocado, olive oil, nuts)
Any foods you dislike or want to avoid?
How many meals do you typically eat per day?
Do you prep your meals or eat out more often?
How much time do you have to prep meals? (e.g., <15 mins, 30 mins max)
Do you consume alcohol? If so, how often and what kind?
Additional Information
What’s worked well for you in the past nutritionally?
What hasn’t worked for you in the past?
Is there anything else I should know to better support you?
What do you expect to achieve by adhering to a meal plan?
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Nutrition Guide Questionnaire

Client Information

Lifestyle & Sleep

Training & Activity

Nutrition & Preferences

Additional Information