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Nutrition Client Intake Form

Welcome to Zenith Lifestyle Nutrition! This form is designed to help me understand your unique nutritional needs, preferences, and goals. By gathering detailed information about your lifestyle, dietary habits, and health, we can create a personalized nutrition plan tailored specifically to you.

Please take your time to answer each section thoroughly. Your responses will guide me in providing you with the most effective strategies to meet your goals—whether it's improving your overall wellness, enhancing your performance, or preparing for a specific event.

What We’ll Cover:
- Personal and lifestyle details (work schedule, activity levels)
- Current eating habits and preferences
- Dietary restrictions or allergies
- Fitness and wellness goals
- Medical history and any current health concerns

Your journey to simplify your nutrition and elevate your life starts here! 

I look forward to supporting you every step of the way.


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Full Name *
Age *
Age *
Height  *
Weight *
Body Fat Percentage
What does a typical day of eating look like for you? *
Dietary Restrictions (Allergies, Religious Reasons) *
Current or past medical issues (Diabetes, IBS, Lactose intolerance etc.) 
When do you wake up? *
When do you typically exercise/workout (Morning, Mid day, Evening) *
Are you currently taking any medications? If yes please elaborate what you are taking. *
Are you taking any supplements? If yes list and mention dosage. *
What is your goal in regards to fitness/nutrition? *
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