Nutrition Coaching Form Name * First Name Last Name Health Information Do you have any allergies or dietary restrictions? * Do you have any medical conditions that affect your diet? * Are you currently taking any medications or supplements? If so, please list them. * Current Eating Habits How many meals do you typically eat per day? * Do you often snack between meals? If so, what do you usually eat? * To the best of your ability describe the average breakfast including any drinks that may be had with the meal. * To the best of your ability describe the average lunch including any drinks that may be had with the meal. * To the best of your ability describe the average dinner including any drinks that may be had with the meal. * Do you have any food cravings? If so, what are they? * What time of day do you find yourself most hungry? * Goals and Preferences What are your main goals for nutrition coaching? (e.g., weight loss, muscle gain, improved energy) * Are there any specific dietary plans or guidelines you are interested in following? * Are there any foods you absolutely dislike or refuse to eat? * How much time are you willing to dedicate to meal preparation? * Thank you!