Name
*
First Name
Last Name
Gender
*
Female
Male
Non-binary/other
I'd rather not say
Age
*
Email Address
*
If someone referred you, please enter their name
How did you hear about Meat Free Fitness / TJ?
*
If 'other' please specify below
Are there any medical or other reasons why you should not change your diet or engage in any form of exercise?
*
No
Yes (please specify)
Your Diet (or what you would like your diet to be)
*
Vegan
Vegetarian
Lacto-vegetarian (no meat, fish, or eggs)
Ovo-vegetarian (no meat, fish, or dairy)
Mostly plant-based
Other (please specify below)
What would you like to achieve from the consultations?
*
Please tick all that apply
What's restricting you from achieving your nutrition goals?
*
Please tick all that apply
On your current diet, have you recently been:
*
Gaining weight (please describe below)
Losing weight (please describe below)
Maintaining the same weight
How often do you drink tea or coffee?
*
5+ cups a day
3-4 cups a day
1-2 cups a day
Occasionally
Rarely / never
How often do you drink alcohol?
*
3+ times a week
1-2 times a week
Less than once a week
Rarely / never
Do you currently take any vitamins or supplements?
*
Yes (please describe below)
No
Do you have any medical conditions or are you pregnant?
*
No
Yes (please specify below)
Do you have any food allergies or intolerances?
*
No
Yes (please specify below)
What are your physical goals?
*
Please tick all that apply
What motivates you?
*
Please tick all that apply
What activities / exercise do you currently participate in?
Please tick all that apply
What's your current weight (kg)?
*
How tall are you (cm)?
*
Do you have access to a gym?
*
Yes
No
Would you consider your job physically demanding?
*
No
A little
Yes
How many hours a day do you typically spend in front of a computer?
*
How many hours' sleep do you get in a typical night?
*
Are there any other relavent comments or information you'd like to provide?
Food diary - weekday 1
This is optional but filling out a quick three-day food diary will help me assess where things can be improved. It also provides a useful point of reference to look back on in the future and to see how your diet has changed over time. Please pick three typical days and try to list everything you eat and drink (including tea, coffee, alcohol) and note the timings of each. And try to be as honest as possible - remember there are no right or wrong answers, but accuracy will help with my assessment.
Food diary - weekday 2
Food diary - weekend day
