SBNUTRITIONGEEK DIET QUESTIONNAIRE
Congratulations! I am excited to start working with you on a nutrition plan that will help you feel strong, build lean muscle, and help you meet your nutrition and health goals. To get started I will need a basic food journal so that I can get a baseline on your current eating habits. Please be as accurate as possible for both quantity and description as it will help me uncover any dietary areas we will need to focus on. Please also list all beverages and meal times in the journal. Recording an example of a typical day during the week and also one during the weekend is helpful. Let’s start with a few basic questions:
Email address *
Name: *
Your answer
Age: *
Your answer
Height: *
Your answer
Weight: *
Your answer
Do you have any medical issues or food allergies/intolerances that I should be aware of? *
Your answer
What medications are you currently taking? *
Your answer
What is your main goal that you would like to focus on? Weight loss? Weight gain? Healthy eating habits? *
Your answer
Are there any foods that you extremely dislike? *
Your answer
Is there a food product or certain meal that must be included in the meal plan? (example: I need to eat oatmeal each morning to settle my stomach) *
Your answer
How often do you cook dinner and what level of cooking do you feel comfortable with? I cook _____ times a week *
Your answer
Indicate the description that best applies: *
What grocery stores do you buy the majority of your food from? *
Your answer
How often do you eat out each week and what are the places you most frequent/favorite items on the menu? *
Your answer
Are you physically active? If so, what do you do to exercise and how often during the week? *
Your answer
Are there any instances that make it difficult to prepare and/or eat regular meals during the week? As a result do you often skip meals? *
Your answer
Diet Journal: Please list all food items and beverages consumed for 2 days (preferably one weekday and one day on the weekend) *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy