Nutrition Questionnaire

This data capture document will form the basis of what I need to know to coach you in the most effective way. Please answer the questions below in as much detail as possible, be honest with your answers, there are no right or wrong answers and no such thing as too much detail. All of this information is confidential and will enable me to coach you in the most effective way possible for you to reach your goals.

You can download the document, complete it on your computer, save it and then email it me back over with full length front on, side on, and back photos to or complete the form below.

Please note; some of the questions below require you to provide a rating score from 1-5: 1 is worst/lowest and 5 is the best/highest.

Name *
What are your energy levels like throughout the day? Please rate 1-5 the following times of the day
Please give information for each day of the week(morning or evening), the activity, the duration:
Please state the day(s) and AM and/or PM
If Male: Based on the below picture what would you say your body fat percentage is? Picture source:
If Female: Based on the below picture what would you say your body fat percentage is? Picture source:
Screen Shot 2017-10-16 at 15.48.51.png

Thank you for taking the time to fill out this questionnaire. The more your coach knows about you, the more your plan can be tailored to your needs, preferences and abilities. Detail is important, and what works for one person may be a catastrophe for another due to a small and seemingly irrelevant variable. Nutrition Coaching is a partnership with two-way responsibility. Keep giving your coach honest feedback and always answer questions truthfully as well as providing additional information which you feel is important. The more information you give, the more effective our sessions will be.

Please note all information is treated in the strictest of confidentiality.