Nutrition Support Group
To be completed and returned prior to entering the group. This will provide me with additional information about you to ensure I can tailor the advice to you and your goals. Once you complete the questionnaire you will be sent to the Facebook group. Please apply to join it then look out for a follow up email to set up the direct debit payment. Once this is confirmed you will be accepted into the group.
Date Of Birth
Sport/Position (If applicable)
What are your main objectives/goals?
How would you rate your activity levels?
Mostly Inactive or Sedentary (Mainly Sitting)
Fairly Active (Include Walking and Exercise 1-2 Times a Week)
Moderately Active (Exercise 2-3 Times a Week)
Active (Exercise Hard More Than 3 Times a Week)
Very Active (Exercise Hard Daily)
Please give an overview of your current diet/dietary habits
Please list your usual forms of exercise. (include duration, intensity and types of exercise as well as how many times a week you do each one.)
Do you suffer or have you been diagnosed with any medical conditions? (Please detail where appropriate)
Do you have any dietary allergies? (Please detail where appropriate)
Do you limit your food intake due to any of the following lifestyle choices?
Do you use any supplements? If yes, please give details.
Do you limit your food intake due to religious reasons? If yes, please specify
Are there any foods you eat regularly due to your ethnic background?
Are there any foods you avoid because of your ethnic background?
Which of the following best describes your shopping habits?
I shop once a week
I shop twice a week
I shop several times a week
I mainly eat out
Which of the following best describes your food preparation habits?
I generally cook using fresh produce (vegetables, meat etc)
I generally cook using processed foods
I generally get take-aways (e.g. pizza, Chinese, Indian)
I mainly eat out in restaurants
I generally eat my main meals at work/uni and have snacks at home
I generally eat a combination (home cooked/take-away/work or uni cafeteria
How would you describe your appetite?
Do you enjoy eating food?
Do you eat at the same time every day?
Do you regularly skip meals? If so please select the relevant option(s)
Don't skip meals
Do you drink milk regularly?
I don't drink milk
I drink whole milk
I drink semi skimmed milk
I drink skimmed milk
I drink nut milks
I drink soya milk
Are there any foods you eat regularly because you think they are healthy?
Are there any foods you avoid because you think they are unhealthy?
Are there any foods you eat regularly because you like them?
Are there any foods you avoid because you don't like them?
Do you drink alcohol?
I don't drink alcohol
I drink alcohol most weekends
I drink alcohol most weekends and sometimes during the week
I only drink alcohol on special occasions
I work in a job where i must socialise frequently
I sometimes drink alcohol after training/competition
Please add any further notes you feel would be useful
To assist me with marketing, please indicate how you heard about me
Referred By A Friend
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