New Client Food Preference Questionnaire

Name* This field is required.

First Name

Last Name

Email* This field is required.

example@example.com

Phone Number* This field is required.

Please enter a valid phone number.

How would you consider yourself?* This field is required.

Vegan

Vegeterian

Pescatarian

None of these

Are you allergic to any of the following foods? Please select all that apply.* This field is required.

Peanuts

Tree nuts

Sesame

Dairy

Shellfish

Fish

Egg

Wheat/Gluten

Soya

Celery

Mustard

Other

What foods do you typically eat for breakfast?* This field is required.

What foods do you usually eat for lunch? * This field is required.

What foods do you typically eat for dinner?* This field is required.

What foods do you typically eat for snacks?* This field is required.

What liquids/drinks do you typically have throughout the day?* This field is required.

What foods do you typically eat when you have cravings?* This field is required.

Please list the times of the day you typically eat each meal (breakfast, lunch, dinner, snacks).* This field is required.

Please indicate how much you like the following foods.* This field is required.

Which of the following do you consider the most when eating a meal?* This field is required.

Comfort of the place

A good location

Time to cook

Grab and go options

Variety

Taste

Nutrition Facts

Service speed

Price

Portion size

Other

Do you usually add salt to your food?* This field is required.

Never

Sometimes

Generally

Always

Do you usually add sugar to your food?* This field is required.

Never

Generally

Sometimes

Always

How much water do you drink each day?* This field is required.

Less than 0.5 liters

0.5-1.5 liters

1.5-3 liters

More than 3 liters

Do you drink alcohol? If yes, please explain how often. If no, enter n/a.* This field is required.

Have you ever tried dieting, following a meal plan, or hired a nutrition coach in the past? If yes, please explain how it went. If no, what is your reason to start now?* This field is required.

What other information would you like to add?* This field is required.

Are you ready, willing, and able to build new daily habits and eat healthier at a pace you are comfortable with? Please explain yes/no and why.* This field is required.

I am a new client and only interested on how many calories and macros I should consume, nothing else. This is a quick one-time purchase, no other services included.If you are interested in a meal plan, ongoing coaching, and/or nutritional coaching for 2+ months, contact Nez.

My Bag

One-time Calorie/Macro/Portion Analysis PDF OnlyEnter description
$29.99Edit
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Custom Meal Plan and 45min Phone Call Analysis
$99.00Edit
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Please verify that you are human so I know I'm not asking robots to eat more vegetables lol.* This field is required.