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.

Cheers,
Craig

Email address *
Name *
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Date Of Birth *
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Email *
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Phone *
Your answer
Height *
Your answer
Weight *
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Home Town/City *
Your answer
Occupation *
Your answer
Sport/Position (If applicable)
Your answer
What are your main objectives/goals?
Your answer
How would you rate your activity levels?
Please give an overview of your current diet/dietary habits
Your answer
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.)
Your answer
Do you suffer or have you been diagnosed with any medical conditions? (Please detail where appropriate)
Your answer
Do you have any dietary allergies? (Please detail where appropriate)
Your answer
Do you limit your food intake due to any of the following lifestyle choices?
Do you use any supplements? If yes, please give details.
Your answer
Do you limit your food intake due to religious reasons? If yes, please specify
Your answer
Are there any foods you eat regularly due to your ethnic background?
Your answer
Are there any foods you avoid because of your ethnic background?
Your answer
Which of the following best describes your shopping habits?
Which of the following best describes your food preparation habits?
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) *
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Do you drink milk regularly? *
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Are there any foods you eat regularly because you think they are healthy? *
Your answer
Are there any foods you avoid because you think they are unhealthy?
Your answer
Are there any foods you eat regularly because you like them?
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Are there any foods you avoid because you don't like them?
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Do you drink alcohol?
Please add any further notes you feel would be useful
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To assist me with marketing, please indicate how you heard about me
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