Name *

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What are your nutrition goals?

Select all that apply

Eat more high-quality foods

Eat fewer low-quality foods

Develop an eating plan

Develop more consistent eating habits day to day

More food variety in diet

Eliminate a food or type of food

Increase energy

Improve sleep quality

Better performance for a sport/activity

Increase muscle mass

Reduce body fat

Other

What are your current nutrition challenges?

Select all that apply

Lack of motivation

Trouble controlling food cravings

Eating too many low-quality foods

Not eating enough high-quality foods

Not eating the right foods to support my goals

No structure/consistency

Difficult schedule to manage

Too many social events

Eating preferences of family members do not align with my goals

Tendency to over eat

Tendency to under eat

Too much snacking

Stress eating

Stress under eating

Eating out of boredom

Other

Which of the following describe your eating preferences and habits?

Select all that apply

Enjoy healthy foods

Dislike healthy foods

Enjoy cooking

Dislike cooking

Have time to cook/prepare meals

No time to cook/prepare meals

Avoid packaged/prepared meals

Tend to opt for packaged/prepared meals

Plan meals

Do not plan meals

Enjoy eating a variety of foods

Enjoy eating the same foods regularly

Dislike eating the same foods regularly

Most meals are eaten at home

Most meals are out to eat

Which of the following eating techniques and strategies do you have experience with?

Select all that apply

Calorie counting

Macro counting

Weighing food portions

Reading food labels

Reading ingredient list of foods

Food tracking/journaling

Cutting

Bulking

Clean eating

Vegetarian

Vegan

High-frequency meals

Intermittent fasting

Keto

Low-carb

Low-fat

High protein

Other

Which of the following liquids do you regularly consume?

Select all that apply

Soda

Energy drinks

Diet soda

Juice

Sports drinks

Coffee

Coffee additives (sugar, cream, syrups, milk, etc.)

Milk

Tea

Pre-workout drink

Protein drink

Which of the following types of alcohol do you consume?

Select all that apply

No alcohol

Liquor/spirits

Mixed drinks/cocktails

Canned seltzers/mixed drinks/cocktails

Beer

Cider

Wine

Other