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Nutrition Coaching Intake
A few honest answers help far more than perfect ones. Nobody is judging.
Your name
*
(required)
Email address
*
(required)
Phone number
Date of birth
*
(required)
Your goals
What would you like to work on?
*
(required)
Losing fat
Gaining muscle
More energy
Better digestion
Managing a condition
Sports performance
A better relationship with food
Menopause or hormonal changes
In your own words, what would success look like?
*
(required)
Is there a date you're working towards?
*
(required)
Select…
No
Within 3 months
3 - 6 months
An event with a fixed date
A normal day
What did you eat and drink yesterday?
*
(required)
How many times a day do you usually eat?
*
(required)
Select…
Once
Twice
Three times
Three plus snacks
I graze throughout the day
Who cooks?
*
(required)
Select…
Me, most days
Someone else
We share it
Mostly ready meals
Mostly eating out or takeaway
How often do you eat out or order in?
*
(required)
Select…
Rarely
Once a week
2 - 4 times a week
Most days
Alcohol
*
(required)
Select…
None
A few units a week
Most days
Heavily at weekends
Prefer not to say
Lifestyle
What's your working day like?
*
(required)
Select…
Desk-based
On my feet
Physically demanding
Shift work
Variable
How well do you sleep?
*
(required)
Select…
Well, 7+ hours
Enough but poor quality
Under 6 hours
Very variable
How active are you?
*
(required)
Select…
Not at all
Walking only
1 - 2 sessions a week
3 - 4 sessions a week
5+ sessions a week
Health
Medical conditions
Medication and supplements
Allergies, intolerances or foods you avoid
*
(required)
Have you tried structured plans before?
*
(required)
Select…
No
Yes, and they worked for a while
Yes, and they didn't
Many times
Leave this field empty
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