Client Nutrition Assessment Form

Intake Form

Instructions for Completing the Form: Please fill out this form as completely and accurately as possible. The information you provide will be essential in helping us design a personalized diet and workout plan that meets your nutritional needs and health goals. If you are unsure about any questions or need clarification, feel free to ask for assistance.

1. Be thorough: Provide detailed answers when possible, especially regarding your diet, medical history, and lifestyle.
2. Review your answers: Before submitting the form, please review your responses to ensure accuracy.

By completing this form, you are taking an important step toward achieving your health and wellness goals. Thank you for your cooperation and trust.

Do you have any chronic illnesses or health conditions? If yes, please specify.

Are you currently taking any medications? If yes, please list them.

Do you have any known allergies or food intolerances? If yes, please specify

Do you have any dietary restrictions (e.g., vegetarian, non vegetarian, vegetarian but eat eggs, vegan, kosher, halal)

Describe your typical daily diet: - Breakfast: - Lunch: - Dinner: - Snacks:

Do you consume alcohol? If yes, how frequently and how much?

Do you use tobacco products? If yes, what type and how often?

Are there any specific foods you want to include or avoid in your diet plan?

How often do you prefer to eat during the day (number of meals and snacks)?

What are your preferences regarding meal preparation? (e.g., quick recipes, batch cooking, specific cuisines)

How much time do you typically have to prepare meals each day?

Do you have access to any kitchen appliances (e.g., blender, food processor, slow cooker)?

Is there anything else you think is important for your diet plan that we haven’t covered?

Where do you like to workout?

How frequently do you have time to exercise?

Name the days you're available to exercise?

Do you have any existing injuries or conditions that I should be aware of while building your training plan?

Why do you want to achieve your dream fitness and physique so badly?

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