Questionnaire


I. Goals/Health History

What are your goals?

Do you have any health conditions?

Do you have any food allergies?

II: Nutrition

Describe what you eat on a typical day

List your favorite meats

List your favorite vegetables

List your favorite fruits

List your favorite carbohydrates (potatoes, rice, pasta, etc.)

If you are a vegetarian, please list your protein sources

What foods do you crave?

How much water do you drink every day?

Are you currently taking a multi-vitamin or any other dietary supplements?

Are you taking protein shakes? If not, will you be willing to get additional protein from supplementation?

III: Exercise

Do you currently exercise? If yes please describe your exercise regimen. If no, how long has it been since you have exercised?

IV: Contact Information

Full Name*

Address

City

State/Province

Country*

Email*

Phone*

Age

Sex*

Height

Weight


Contact Justin