CLIENT QUESTIONnaiRE: Part THREE

This questionnaire is designed to gather important information surrounding your lifestyle and nutrition, so that we can put together a 'Lifestyle Plan' to support your goals. The more information you can give, the better advice we can give you in return. Lifestyle factors, stress and nutrition play a huge role in your results.

There are 4 separate forms. Please fill out your name and click 'Submit' before moving onto the next form. This information is confidential.

FOOD & NUTRITION
Please explain your current food/nutritional intake (quantity & quality). For example, "I usually eat around 4 meals per day with snacks in between. Most meals have protein, carbs, and veg. I tend to binge on junk food on weekends."
How many litres of water do you drink per day?
How often do you drink alcohol?
When do you usually binge? eg. Weekends, mid afternoon
Allergies/intolerances/sensitivities?
How is your digestion? Bloating, inflammation etc
How often do you eat vegetables?
Does your food or alcohol intake change on weekends?