QUESTIONNAIRE

To create a nutrition plan, I need to gather as much information as possible about your current condition, eating habits, and physical activity. Please take your time to fill out this questionnaire carefully and answer in detail and honestly.

BASIC INFO

Full name

Phone number

Date of birth

Height (in cm)

Current weight

Daily activity level

(e.g., sedentary job / physically demanding standing job / active athlete…)

HEALTH STATUS

Diagnosed chronic illnesses

Past injuries and surgeries

Food allergies

Past psychological disorders

(related to food)

Long-term medications

SPORT

Favorite sports activities

What sports have you practiced in the past?

How much time per week do you spend or can you dedicate to exercise?

Do you have experience working with a personal trainer?

NUTRITION

Describe what you ate yesterday

(regardless of whether it was a “good” or “bad” day)

What is your usual eating pattern?

What are your indulgences or guilty pleasures?

Approximately how much water do you drink per day?

Do you drink coffee? If yes, what kind and how often?

Have you ever followed a diet? Which one and with what results?

Do you use any dietary supplements? Which ones?

Are there any foods you avoid? Why?

MOTIVATION

What is your reason or goal for creating a nutrition/training plan? What motivates you?

(e.g., lose weight, gain muscle, start eating healthy, maintain weight, feel good long-term, etc.)

OTHER NOTES

Is there anything else you think I should know?

QUESTIONNAIRE

Contact me.