Nutrition Consultation Form
Coach Kahu
Date
-
Month
-
Day
Year
Date
Name
First Name
Last Name
Email
example@example.com
Height (cm's)
Weight (kg's)
Age (years)
My main goals are focused around
Weightloss
Muscle gain
Strength gain
Athletic performance
Other
List your specific goals from 1-3 in importance - Nutrition wise
What would you like to accomplish during this phase?
What do you eat and drink on a regular basis? (need to be honest)
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. (work, parent life etc.)
Main takeaways and action points from this session to implement.
Submit
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