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 *
Name: *
Age: *
Height: *
Weight: *
Do you have any medical issues or food allergies/intolerances that I should be aware of? *
What medications are you currently taking? *
What is your main goal that you would like to focus on? Weight loss? Weight gain? Healthy eating habits? *
Are there any foods that you extremely dislike? *
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) *
How often do you cook dinner and what level of cooking do you feel comfortable with? I cook _____ times a week *
Indicate the description that best applies: *
What grocery stores do you buy the majority of your food from? *
How often do you eat out each week and what are the places you most frequent/favorite items on the menu? *
Are you physically active? If so, what do you do to exercise and how often during the week? *
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? *
Diet Journal: Please list all food items and beverages consumed for 2 days (preferably one weekday and one day on the weekend) *
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