And welcome to your Pre Health Questionnaire!

Please complete with as much detail as possible.

Name

First Name

Last Name

Macro and Energy Calculations

Age

Current Weight

Goal Weight

Current Exercise Routine

Please provide as much detail as possible including length, exercise type and intensity

Current Health

Please list any pre existing health conditions:

Please list any food allergies:

Please list any food intolerances or other dietary issues:

Please list any known nutritional deficiency issues and any current treatment plans or medications:

Please list anything else that may affect your dietary intake:

Please list your health and nutrition based goals:

Current Diet

With as much detail as possible, please give a description of a "normal" day of eating:

Please list any food/dietary preferences, regardless of reason:

Please list your favourite and go to breakfasts:

Please list your favourite and go to lunches:

Please list your favourite and go to dinners:

Please list your favourite and go to snacks:

Is there anything else you wish to add: