Nutrition & Wellness Profile

Full Name

Age *

Weight *

Medical Conditions *

Medications or Supplements *

Allergies or Food Sensitivities (if any) *

Digestive Issues *

Current Eating Patterns *

Typical Daily Intake: A 1- to 3-day food diary or a description of a typical day’s meals and snacks *

Meal Timing *

Beverage Intake *

Dietary Preferences *

Favorite Foods *

Foods to Avoid *

Weight Loss Target *

Challenges *

Portion Control Issues: Any known difficulties with estimating portions *

What drives you to lose weight (health, appearance, energy, etc.). Try and dig deep here, not just surface level *

Do you have a supportive environment at home or friends involved in the journey? *

Past Diet Experiences: Any diets you've tried before and what worked/didn’t work for you? *