Pre Consultation FormStep 1 of 616%Personal InformationName(Required) First Last Age(Required)Gender Male FemaleEmail(Required) Phone(Required)ProfessionHealth Related QuestionsHeight in ftWeight in kgDo you have any medical conditions? Yes NoAdditional InformationCurrently taking any medications or supplements? Yes NoAdditional InformationEating habits and preferencesHow many meals you take in a day? 1 meal 2 meal 3 meal More than 4Do you snack between meals? Yes NoWhich foods you like the most?Which foods you like the least?How often do you eat out or order takeout food? Never Once a week 2–3 times a week 4–6 times a week DailyHydration and SleepHow much water do you drink daily (in liters)? Less than 1 liter 1–2 liter 2–3 liters 3–4 liters More than 4 litersOn average, how many hours do you sleep per night? Less than 4 hours 4–5 hours 6–7 hours 8 hours More than 8 hours Abnormal sleep patternPhysical ActivityHow often do you exercise per week? Never Occasionally 1–2 days 3–4 days 5–6 days DailyWhat type of physical activity do you do most? I have no physical activity My job/work requires physical activity I occasionally walk I lift weights I do Yoga/MeditationNutrition GoalsWhat are your top 3 goals with this nutrition plan? I want to lose weight I want to gain weight I want to get in shape I want to be healthyYour target weight?
