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Nutrition Coaching

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Directory

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1 - Personal Information

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Full Name

First Name + Name

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Date of Birth

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Occupation/Industry

Type your occupation here

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Address (optional)

Type your address here or remove this section

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<aside> <img src="/icons/phone-speaker_gray.svg" alt="/icons/phone-speaker_gray.svg" width="40px" /> Contact Information:

Email - [email protected]

Mobile - +123 456 78900

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Select your gender just bellow

• [ ] Female

• [ ] Male

• [ ] Other </aside>

2 - Health Information

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Height

Enter your height here

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Weight

Enter your weight here

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Are you currently taking any medications? If yes, please list them.

Do you have any diagnosed medical conditions? If yes, please specify.

Do you have any food allergies or sensitivities? If yes, please list them.

Please fill out the form below to provide your measurements.

3 - Lifestyle Information

What is your occupation? Describe your work environment (desk job, physically active, etc.).

How often do you exercise?

What type of exercise do you engage in? (e.g., cardio, strength training, yoga)

How many hours of sleep do you typically get per night?

How would you rate the quality of your sleep? (Poor, Fair, Good, Excellent)

On a scale of 1-10, how would you rate your stress levels?

4 - Lifestyle Information

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Do you follow any specific dietary preferences?

• [ ] Vegetarian (Lacto-Ovo, Lacto, Ovo)
• [ ] Vegan
• [ ] Pescatarian
• [ ] Gluten-Free
• [ ] Dairy-Free
• [ ] Kosher
• [ ] Halal
• [ ] Low-Carb (e.g., Keto, Atkins)
• [ ] Paleo
• [ ] Intermittent Fasting </aside>

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Are there any foods you dislike or avoid?

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5 - Fitness Goals

What is your main goal for fitness coaching? (e.g., strength gain, weight loss, improved endurance)

Do you have any other fitness goals you would like to achieve? If yes, please list them.

By when would you like to achieve these goals?

What challenges have you faced in the past regarding fitness and exercise?

6 - Previous Experience