Section 01

Demographics & Anthropometrics

Let's start with some basic information about you.

Section 02

Lifestyle & Activity Level

Tell us about your daily movement and exercise habits.

Section 03

Eating Patterns & Structure

Help us understand how you organize your meals throughout the day.

Section 04

Dietary Intake

How often do you eat the following foods? Use the frequency scale for each group.

Rate how often you eat each food using: Daily · Weekly · Monthly · Rarely · Never

🥩 Proteins

Chicken / Turkey
Red Meat
Fish / Seafood
Eggs
Plant Proteins (beans, lentils, tofu)

🥛 Dairy / Alternatives

Milk
Cheese
Yogurt
Plant-based Milk

🌾 Carbohydrates

Whole Grains
Refined Grains (white bread, pasta)
Sugary Foods (desserts, candy)

🥦 Fruits & Vegetables

Fruits
Vegetables
Leafy Greens

🫒 Fats

Fried Foods
Fast Food
Nuts / Seeds
Healthy Oils (olive oil, butter)

💧 Hydration

Section 05

Clinical & Nutritional Risk

This helps identify any underlying health conditions that affect nutrition.

Section 06

Symptom Screening

Do you experience any of the following? Select all that apply.

Section 07

Behavioral & Psychological Factors

Your relationship with food matters just as much as what you eat.

Section 08

Sleep & Recovery

Sleep is deeply connected to metabolism, hunger hormones, and overall health.

Section 09

Social & Environmental Factors

Context shapes what, how, and why we eat.

Section 10

Goals & Motivation

Let's make sure we understand what you're working toward.

Not at all Extremely

Your Information

So we can personalize your report and help you schedule an appointment.