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Diet and Nutrition
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Name
*
First
Last
Phone
Email
*
Age
*
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Choice 77
Height
*
Weight
*
Gender
Occupation
Nutrition & Diet
Do you have any dietary restrictions or preferences ?
*
Do you have any food preferences or dislikes (e.g. foods you refuse to eat)
Do you follow any specific diet ?
Standard (no restrictions)
Gluten Free
Diary Free
Vegan / Vegetarian
Paleo / Keto / Low Carb
Other (please Specify Below)
Please give details below
How many meals per day do you prefer ?
2
3
4
5+
Do you snack ?
No
Yes
If so what do you actually eat ?
Do you have any cravings (sweets, salty etc ?)
How many litres of water do you drink oer day ?
1L
1L - 2L
2L - 3L
3L+
Do you drink alcohol ?
Never
Occasionally
Regularly
Do you consume caffeine (coffee, energy drinks, etc ?)
Never
Occasionally
Daily
Are you currently tracking your calories or macros ?
*
Yes
No
Sometimes
do Estimated follow
Estimated daily calorie intake (if known)
Lifestyle & Habits
How many hours sleep do you get on average ?
<4
4-6
6-8
8+
How would you describe your stress levels ?
Low
Moderate
High
Do you have any digestive issues (bloating, IBS etc ) ?
Yes
No
Sometimes
Do you take any supplements ?
No
Yes
Please state which ones
Additional Information
Whats the biggest challenge you face with nutrition ?
What would make this diet plan easy for you to follow ?
Is there anything else I should know before creating your plan ?
Payment
Single Item
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Price:
£49.00
Total
£0.00
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Niall Hesson
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Niall
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