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NUTRITION ASSESSMENT FORM 🤍
This form helps me understand your current eating habits, preferences and routine so I can create a nutrition plan that fits your lifestyle.
Name
First Name
Last Name
What is your main nutrition goal?
How would you describe your current eating habits?
How many meals do you usually eat per day?
2
3
4
5
6
What does a typical day of eating look like for you? Please include meals, snacks and drinks.
Do you have any food allergies or intolerances?Please list all allergies/intolerances and describe the reaction if relevant.
Are there any foods you do not like or do not want included in your plan?
What are your favourite foods or meals?
How often do you eat out or order food?
Rarely
1–2 times per week
3–4 times per week
5+ times per week
What is your biggest challenge with nutrition right now?
How much water do you usually drink per day?
Less than 1 L
1–1.5 L
1.5–2 L
2–3 L
3+ L
Do you regularly drink alcohol, soft drinks, juices or energy drinks?
Do you take any supplements?
Do you experience any digestive issues such as bloating, constipation, reflux or discomfort?
Is there anything else I should know before creating your nutrition plan?
Submit
Should be Empty: