Personalized Blueprint™ Discovery Questionnaire

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First, what should I call you?* This field is required.
First Name
Last Name
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What's the best email address for you?* This field is required.I'll use this for communication about your Personalized Nutrition Blueprint™.
example@example.com
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What's your date of birth?* This field is required.
Date
Day
Month
Year
4
Where do you live?* This field is required.This will help us personalize food availability, grocery recommendations, restaurant guidance, measurements, and other practical pieces of the Blueprint.
City, State/Province, and Country
5
Tell me a little more about the life you're living right now.* This field is required.Think about work, family, relationships, responsibilities, routines, or any major changes happening in your life. What does life look like for you these days?
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Who do you typically prepare meals for?* This field is required.Choose all that apply
Just myself
My spouse or partner
My children
Other family members
My household varires depending on the day
Someone else usually does most of the cooking
other
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What is the primary goal you'd like your Personalized Nutrition Blueprint™ to support right now?* This field is required.Choose the one that feels most important right now. We'll have space to talk about everything else that matters to you, too.
Lose body fat
Build or maintain lean muscle
Improve my energy
Improve my overall health
Create more consistent eating habits
Feel more confident with nutrition
Improve my relationship with food
Support my body through perimenopause or menopause
Support a specific health need
Maintain my current weight and feel my best
Other
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What else would you love for your nutrition and lifestyle to support?Choose everything that feels meaningful to you. Your primary goal gives us direction, but these help me understand the bigger picture of what "feeling better" means to you.
More consistent energy
Better digestion
Better sleep
Improved strength
Building or maintaining lean muscle
Fat loss
Weight maintenance
Better workout performance and recovery
Hormonal health
Heart health
Healthy aging and longevity
Reduced inflammation
Feeling more comfortable in my body
A more peaceful relationship with food
Less stress around deciding what to eat
Greater confidence making food choices
More consistent habits
Better hunger and fullness awareness
Feeling more prepared and organized
other
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Why does this goal matter to you, and what would you love to see change in your everyday life?* This field is required.Think beyond a number on the scale. How would you like to feel differently in your body, health, confidence, energy, or everyday life? What would make you think, “Yes—this is working”?
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What feels like the biggest challenge between where you are now and where you want to be?* This field is required.You don't need to have the solution. Tell me what feels difficult, frustrating, confusing or hard to sustain right now?
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What parts of your life do you want to protect while working toward your goals?* This field is required.Think about the things you don't want healthy living to take away from - family meals, date nights, restaurants, travel, celebrations, favorite foods, social events, time with people yo love, or simply having flexibility. What matters to you?
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A few details about your body right now* This field is required.These numbers simply give me a starting point for calculating your personalized nutrition needs. They don't define your health, your progress, or your success.
Height, Current weight, Goal weight(if you have one)
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Are there any health conditions, diagnoses, or ongoing health concerns I should consider when creating your Blueprint?* This field is required.Please include anything you feel may affect your nutrition, digestion, energy, appetite, weight, recovery, or food choices. If non, simply write "None."
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What medications and supplements are you currently taking?* This field is required.Please include prescription and over-the-counter medications, vitamins, minerals, herbs, protein/nutrition supplements, or other products you use regularly. Include doses if you know them and note which are medications versus supplements. If none, write “None.”
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Do you have any food allergies, intolerances, sensitivities, or foods that regularly cause symptoms?* This field is required.Please tell me which foods or ingredients you avoid and what happens when you eat them, if you know. Include diagnosed allergies as well as foods you've learned simply don't feel good in your body. If non, write "None."
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Do you regularly experience any of the following digestive concerns?* This field is required.
Bloating
Gas
Constipation
Diarrhea or loose stools
Heartburn or acid reflux
Abdominal discomfort or cramping
Feeling overly full after meals
Nausea
Irregular bowel movements
None of these
Other
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Which best describes where you are right now.* This field is required.
I have regular menstrual cycles
My cycles have become irregular or are changing
I believe I am in perimenopause
I'm postmenopausal
I've had a hysterectomy and/or oophorectomy
I use hormonal birth control that affects my cycle
I'm not sure
Other
18
Are you currently experiencing any of there changes or symptoms?
Hot flashes or night sweats
Changes in sleep
Changes in energy
Changes in appetite or hunger
Changes in body composition or where you carry body fat
Changes in menstrual cycle
Mood changes
Brain fog or difficulty concentrating
Vaginal dryness
Changes in libido
None of these
Other
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Is there anything about your menstrual cycle, hormonal health, symptoms, HRT, or this stage of life that you’d like me to consider when building your Blueprint?
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Do you have any injuries, chronic pain, or physical limitations that affect your activity, cooking, shopping, exercise, or everyday life?* This field is required.If yes, tell me what you’d like me to consider. If no, write “None.”
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How would you describe your sleep most nights?* This field is required.
I usually sleep well and wake feeling rested
I sleep fairly well but don't always feel rested
I have trouble falling asleep
I wake frequently during the night
I tend to wake too early
My sleep is inconsistent
I regularly don't get enough sleep
Other
22
When you’re stressed or overwhelmed, what tends to happen with your nutrition or self-care?* This field is required.
I forget to eat or go too long without eating
I lose my appetite
I snack or graze more
I eat for comfort
I crave certain foods more
I eat larger portions than usual
I rely more on takeout or convenience foods
I stop planning or preparing meals
I drink less water
I exercise less
I sleep less or poorly
I become more rigid or restrictive with food
I tend to think, “I’ll start again later”
My habits don’t change much
Other
23
Walk me through a typical day of eating for you right now.* This field is required.Choose a recent, ordinary day—not your “best” day. Starting when you wake up and ending when you go to bed, tell me approximately when you ate or drank and what you had. Include meals, snacks, beverages, bites while cooking, evening snacks—anything that’s normally part of your day. You don’t need to know exact portions.
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Does the way you eat change much on weekends or days off?* This field is required.
No- my eating is pretty similar throughout the week
A little- timing or food choices change somewhat
Yes- weekends/days off look very different
My schedule varied so much that I don't really have typical weekdays and weekends
25
Does the way you eat change much on weekends or days off? If so, tell me what usually changes.Think about meal timing, sleeping later, restaurants, social plans, alcohol, snacks, family meals, or anything else that makes these days different.
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When do you tend to feel the most hungry?* This field is required.
First thing in the morning
Mid-morning
Around lunchtime
Early afternoon
Late afternoon
Around dinnertime
In the late evening after dinner
Late at night
My hunger feels pretty steady throughout the day
I don't notice hunger very often
Other
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Walk me through the timing of a typical weekday* This field is required.Approximately what time do you wake up, start work or your main responsibility, have breaks or opportunities to eat, exercise if you do, finish work, get home, and go to bed? Include anything that affects when you're realistically able to eat.
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Are there certain days of the week when your schedule is significantly different?For example: longer workdays, early mornings, late meetings, travel, children's activities, regular social plans, different workout times, or anything else I should plan around.e
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What do you typically drink throughout the day?* This field is required.Include water, coffee, tea, soda, juice, energy drinks, alcohol or other regular beverages. Approximate amounts are helpful.
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How do you feel about using calories, macros or portion measurements as part of your Blueprint?* This field is required.
I like having specific numbers and structure
Numbers are helpful, but I don't want to rely on them forever
I'm comfortable using them occasionally as a reference
Tracking tends to make me feel stressed or overly focused on food
I would prefer as little tracking as possible
I'm not sure yet
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Is there anything about your past experience with tracking, weighing, or measuring food that you'd like me to know?Tell me what helped, what didn't, or how it made you feel. If you don't have experience with it, you can leave this blank.
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How often do you typically eat restaurant, takeout, or delivery meals?* This field is required.
Rarely
About once a week
2-3 times per week
4-5 times per week
Most days
It varies quite a bit
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Are there particular restaurants, cuisines, or takeout meals that are a regular part of your life?Tell me about anything you'd like your Blueprint to help you keep enjoying rather than feeling like you need to avoid.
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Which protein foods do you enjoy and would be happy to see in your Blueprint?* This field is required.Choose everything you genuinely enjoy. Selecting something doesn't mean it has to appear in you plan.
Chicken breast
Chicken thighs
Turkey
Ground turkey
Lean ground beef
Steak
Pork
Ham
Salmon
Tuna
White fish
Shrimp
Other seafood
Eggs
Egg whites
Greek yogurt
Cottage cheese
Cheese
Tofu
Tempeh
Beans
Lentils
Protein powder/shakes
Protein bars
Other
35
Which carbohydrate and starch foods do you enjoy and would be happy to see in your Blueprint?* This field is required.Choose everything you genuinely enjoy. We'll use your preferences to create variety and realistic swaps.
White rice
Brown rice
Jasmine or basmati rice
Quinoa
Potatoes
Sweet potatoes
Oatmeal/oats
Bread or toast
English muffins
Bagels
Tortillas or wraps
Pasta
Couscous
Crackers
Rice cakes
Cereal
Granola
Beans
Lentils
Corn
Other
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Which fruits do you enjoy?* This field is required.
Strawberries
Blueberries
Raspberries
Blackberries
Apples
Bananas
Oranges or mandarins
Grapes
Pineapple
Mango
Peaches or nectarines
Pears
Melon
Kiwi
Cherries
Dried fruit
Other
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Which vegetables do you enjoy?* This field is required.
Broccoli
Cauliflower
Green beans
Asparagus
Brussels sprouts
Spinach
Lettuce/salad greens
Kale
Bell peppers
Cucumbers
Tomatoes
Carrots
Zucchini or summer squash
Mushrooms
Onions
Cabbage
Peas
Mixed vegetables
Other
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Which of these foods and flavors do you enjoy?* This field is required.
Avocado
Olive oil
Butter
Peanut butter
Almond or other nut butter
Almonds
Walnuts
Cashews
Other nuts
Seeds
Cheese
Hummus
Guacamole
Salsa
Pesto
Salad dressings
Mayonnaise
Mustard
Hot sauce
Soy sauce or tamari
Teriyaki-style sauces
Other
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Are there any foods, ingredients, flavors, or textures you dislike or simply don’t want included in your Blueprint?You don’t need a medical reason. If you don’t like it, I don’t need to put it in your plan.
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What kinds of breakfasts do you actually enjoy?* This field is required.
Eggs or egg-based breakfasts
Toast or English muffins
Oatmeal or overnight oats
Greek yogurt or yogurt bowls
Smoothies
Protein shakes
Breakfast sandwiches or wraps
Cereal
Fruit
Cottage cheese
Pancakes or waffles
Something savory
Something sweet
Grab-and-go options
I usually prefer to skip breakfast
Other
41
What does lunch usually need to look like for your life?* This field is required.
I have time to sit down and eat a full meal
I need something quick but can still sit down to eat
I usually eat while working or doing other things
I need something portable or grab-and-go
I often have very little time to eat
I work from home and have access to my kitchen
My lunch situation varies depending on the day
Needs to be portable
Needs to be quick
No reheating required
Other
42
What kind of lunches do you enjoy?* This field is required.
Protein + rice or another grain + vegetables
Protein + potatoes + vegetables
Salads with protein
Wraps or sandwiches
Grain or rice bowls
Soups or stews
Leftovers from dinner
Pasta-based meals
Snack-style meals or plates
Prepared or convenience meals
Restaurant or takeout lunches
Something light
Something substantial
Other
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What kinds of dinner do you enjoy most?* This field is required.
Protein + vegetables + rice or another grain
Protein + vegetables + potatoes
Pasta dishes
Tacos, fajitas, or burrito bowls
Stir-fries
Salads with protein
Soups, stews, or chili
Burgers or sandwiches
Sheet-pan or one-pan meals
Casseroles or baked dishes
Grilled meals
Slow cooker meals
Restaurant or takeout meals
Simple meals with very little preparation
Other
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What kinds of snacks do you actually enjoy?* This field is required.
Fruit
Greek yogurt
Cottage cheese
Cheese
Nuts or seeds
Nut butter
Crackers
Rice cakes
Hummus and vegetables
Protein shakes
Protein bars
Smoothies
Popcorn
Chips or salty snacks
Chocolate or something sweet
Baked goods
Snack plates with several different foods
Leftovers or small portions of meals
Other
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What foods do you absolutely love and want to keep in your life?* This field is required.Anything counts-pizza, tacos, pasta, burgers, chocolate, ice cream, baked goods, chips, wine, a favorite restaurant meal, a family tradition...Tell me what you genuinely enjoy and wouldn't want a healthy lifestyle to require you to give up.
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What meals, foods, or specific products are already easy and reliable for you?* This field is required.Think about meals you make regularly, foods you almost always keep available, favorite brands, convenience foods, snacks, or restaurant/takeout meals you can reliably turn to.
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On a typical weekday, how much time are you realistically willing or able to spend making a meal?* This field is required.
10 minutes or less
10–20 minutes
20–30 minutes
30–45 minutes
I don’t mind spending longer
It varies depending on the meal/day
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Which approaches work well for you?* This field is required.
Batch cooking
Leftovers
Repeating meals
Ingredient prep
Frozen produce
Pre-cut/pre-washed foods
Pre-cooked proteins
Prepared/convenience foods
Slow cooker
Air fryer
Sheet-pan/one-pan
Simple assembled meals
I strongly prefer fresh meals
Other
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How often do you typically grocery shop?* This field is required.
Several times per week
About once a week
Every 1–2 weeks
I mostly order groceries for delivery or pickup
Someone else does most of the grocery shopping
I don’t have a consistent routine
Other
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Where do you usually buy your groceries?* This field is required.Include the stores, markets, warehouse clubs, or delivery services you use most often.
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How important is grocery budget when I'm choosing foods and recipes for your Blueprint?* This field is required.
Very important — I need to keep food costs as low as reasonably possible
Important — I’d like you to be mindful of cost
Somewhat important — I’m willing to spend more on certain foods
Not a major consideration for me
I’m not sure
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How much variety do you like in your meals?* This field is required.
I’m perfectly happy eating many of the same meals throughout the week
I like some repetition, but I also want a few different options
I prefer quite a bit of variety
I get bored very quickly if I repeat meals
It depends on the meal
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How often does travel or being away from your normal routine affect the way you eat?* This field is required.If travel creates a particular nutrition challenge you’d like your Blueprint to address, tell me in other
Rarely
A few times per year
About once a month
Several times per month
Travel is a regular part of my work or lifestyle
It varies significantly
Other
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Tell me about the different ways you've tried to change your eating or your body in the past.* This field is required.You can include diets, meal plans, calorie or macro tracking, programs, medications, fasting, eliminating foods, or anything else you’ve tried. Tell me what worked, what didn’t, what felt sustainable, and anything you don’t want to repeat.
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Are there foods you currently try to limit, avoid, or feel uncomfortable eating—even though you don’t have a medical reason to avoid them?If yes, tell me which foods and what concerns you about eating them.
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Do any of these patterns feel familiar to you?* This field is required.
I think of some foods as “good” and others as “bad”
I feel guilty when I eat differently than I planned
I sometimes feel like I’ve “blown it” after one meal or choice
I become more restrictive after eating more than I intended
I skip meals or eat less to compensate
I use exercise to compensate for eating
I feel like certain foods need to be earned
I restrict before or after restaurants, celebrations, or special events
I tend to wait for Monday or another “fresh start”
If I can’t follow a plan well, I’m tempted to stop altogether
I feel anxious when I don’t know the calories or macros in something
I frequently second-guess my food choices
None of these feel particularly true for me
Other
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Aside from physical hunger, what else sometimes influences your desire to eat?* This field is required.
Stress
Boredom
Sadness or loneliness
Anxiety
Anger or frustration
Feeling overwhelmed
Fatigue or lack of sleep
Wanting comfort
Wanting a reward or treat
Celebration or happiness
Social situations
Seeing or smelling food
Habit or routine
Cravings
Food being readily available
I don’t notice emotions or situations influencing my eating very much
I’m not really sure
Other
58
How much do you trust yourself to make food choices without a plan, rules, or someone telling you what to do?* This field is required.
A lot — I generally feel confident making choices on my own
Mostly — I trust myself but sometimes second-guess my choices
Somewhat — I feel confident in certain situations but not others
Not very much — I often worry that I’m making the wrong choice
Very little — without structure, I tend to feel lost or out of control
I’m not sure
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Outside of intentional exercise, how active are you during a typical day?* This field is required.
Mostly sedentary — I spend most of my day sitting
Lightly active — I sit quite a bit but also spend some time walking or on my feet
Moderately active — I’m regularly walking, standing, or moving throughout my day
Very active — my work or daily life keeps me on my feet and moving for much of the day
Extremely active — my job or lifestyle involves significant physical activity
It varies significantly depending on the day
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What kinds of intentional exercise or movement are currently part of your life?* This field is required.
Strength training
Walking
Running or jogging
Cycling
Swimming
Pilates
Yoga
Group fitness classes
Dance
Sports
Hiking
Cardio machines
Mobility or stretching
Physical therapy or rehabilitation exercises
I’m not currently exercising regularly
Other
61
How many days per week do you typically exercise intentionally?* This field is required.
None right now
1 day
2 days
3 days
4 days
5 days
6+ days
It varies significantly
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About how long is a typical workout or movement session?An estimate is fine.
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Tell me a little about what your exercise week actually looks like.For example: what you do on which days, how intense it feels, whether you’re following a program, training for something specific, or anything else that would help me understand how you’re currently moving.
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What would you most like your nutrition to support physically?* This field is required.
Having more energy for everyday life
Building muscle
Maintaining muscle as I lose body fat
Getting stronger
Improving workout performance
Recovering better from exercise
Supporting endurance
Feeling less fatigued
Supporting healthy aging
Staying active and independent
Supporting mobility
Returning to exercise after time away
Supporting a specific sport or physical goal
I don’t have a specific physical goal right now
Other
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When it comes to nutrition, how much structure feels most supportive to you?* This field is required.
I like a lot of structure and knowing exactly what to do
I like clear structure with room to make substitutions
I prefer having several options to choose from rather than a set plan
I like general guidelines and a lot of flexibility
Too much structure tends to make me feel restricted
I’m not sure—I’d like your guidance
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Which parts of your Blueprint would you most like clear guidance around?* This field is required.
Calories and nutrition targets
Protein, carbohydrates, and fats
Portion sizes
Meal timing and Meal Rhythm™
What to eat for breakfast
What to eat for lunch
What to eat for dinner
Snacks
Building balanced meals
Grocery shopping
Meal preparation
Quick and convenient meals
Eating at restaurants
Travel and vacations
Favorite foods and desserts
Hunger and fullness
Cravings
Hydration
Supplements
Making substitutions
What to do when life doesn’t go according to plan
Eating well without tracking
Other
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If you could finish your Blueprint feeling completely clear about three things, what would you want those three things to be?* This field is required.Think about the questions you most want answered or the areas where you’d most like to stop second-guessing yourself.
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What would you most like to understand better about nutrition and your own body?* This field is required.
How much food my body actually needs
How calories relate to my goals
How much protein I need
How carbohydrates fit into healthy eating
How dietary fats fit into healthy eating
How to build a balanced meal
How to choose portions without always measuring
How to recognize hunger and fullness
How to tell whether I’m eating enough
How to manage cravings
How to stay satisfied between meals
How to fuel exercise and recovery
How nutrition needs change with age
How nutrition may change during perimenopause or menopause
How to eat for fat loss without feeling overly restricted
How to maintain my results
How to eat at restaurants without overthinking it
How to navigate vacations and travel
How to include favorite foods without guilt
How to make adjustments when life changes
How to rely less on calorie or macro tracking
How to trust myself more around food
Other
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Is there anything I haven’t asked that you think I should know before I build your Blueprint?Tell me anything we haven’t covered that feels important—including something you’d especially like included, something you don’t want included, or anything else that would help me make your Blueprint feel like yours.
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Is there anything you specifically do NOT want included in your Blueprint?This might be a food, type of recommendation, tracking approach, strategy you’ve tried before, or anything else you know isn’t right for you.
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Please confirm the following:* This field is required.
I understand that my Personalized Nutrition Blueprint™ provides nutrition education and guidance and is not medical diagnosis or treatment.
* I understand that I am responsible for discussing recommendations with my healthcare provider when appropriate.
* I confirm that the information I’ve provided in this questionnaire is accurate and complete to the best of my knowledge.
* I understand that my Blueprint will be created based on the information I have provided and that incomplete or inaccurate information may affect the recommendations I receive.
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Your Signature* This field is required.By signing below, you confirm that you have read and agree to the acknowledgments above.
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