Consultation Questionnaire

Name *

First Name

Last Name

How Would you Describe your Average, Weekly Activity Level? *

Select Which Option Applies Most:

Seated work and little to no exercise

Light exercise 1-3 times p/week (e.g. light walking, casual cycling)

Moderate exercise 3-5 times p/week (e.g. brisk walking, golf, hiking)

Hard exercise (6-7 times p/week (e.g. tennis, running, swimming)

What are your weight expectations or goals? *

Select the Option that Best Suites You:

Lose weight

Maintain weight

Gain weight

Which one of the following would you say best describes your body type? *

Lean/thin build, difficulty building muscle

Larger build, often pear-shaped, with difficulty shifting fat

Muscular/ athletic build, gains muscle fairly easily

Nutritional Analysis *

Please select which of the following diets you have actively followed in the last 3 years (select all that apply)

Paleo

Weight Watchers

Low carb

Intermittent fasting

Keto

Vegan

Vegetarian

Low FODMAP

Other