Nutrition Questionnaire

About This Questionnaire

Please provide as much information as possible to allow full analysis of current eating habits and offer the best advice to progress.
First Name *
Last Name *
Date Of Birth *
Age *
What Is Your Occupation *
Phone Number (For Whatsapp) *
Current Weight (kg) *
What Are Your Goals? *
Please list any concerns you have about health, eating habits, health or body? *
What are the top three things you'd like to change? *
Are you regularly active in sports or exercise? *
If you answered yes to the previous question, how many hours per week do you participate in sports or exercise? *
What type of sport/exercise do you do?
How many hours per week do you do other types of physical activity? (gardening, playing with kids, moving around at work, walking to work, DIY etc) *
On average, how many hours of sleep do you get each night? *
Who does the shopping in your house? *
Who does the cooking in your house? *
Do you currently follow a specific diet? (provide details)
Do you have any allergies or specific dietary requirements? (Please give details)
Do you have any health conditions or injuries? (Please give details) *
Are you on any medication or undergoing any treatments? (Please give details) *
Do you currently use the MyFitnessPal app? *
Are you willing to keep an honest food diary for a minimum of 5 days? *
What are your goals in terms of nutrition? (Please provide as much detail as possible) *

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