Gender: *

Age: *

General: 1. What are your specific goals *

General: 2. What timeline would you like to achieve your specific goal in? *

General: 3. How Disciplined are you? *

General: 4. How often do you train in a week? *

General: 5. What form of training do you predominantly do *

General: 6. How would you rate your overall health? (please ensure to expand on this in PAR-Q) *

Nutrition: 1. Have you lost weight before? If so what did you follow, a specific diet? What did you do? *

Nutrition: 2. How many times do you eat per day? (Including snacks) *

Nutrition: 3. Do you regularly eat breakfast? If so what do you eat? *

Nutrition: 4. What time is your last meal? *

Nutrition: 5. How do you feel after having lots of carbohydrates, especially gluten/wheat based products? (IE: bread, pasta, cereal etc– Please tick that applies *

Nutrition: 6. How do you feel after having protein? *

Nutrition: 7. Do you eat and drink any dairy or soya products? *

Nutrition: 8. Would you say you have more of a sweet or savoury tooth? *

Nutrition: 9. Do you ever get any sugar cravings? *

Nutrition: 10. How many cups of tea/coffee/energy drinks per day do you have? *

Nutrition: 11. Do you drink alcohol? If so how often and quantity per week? Unit = either 1 25ml shot of spirit or 275ml of lager/wine. *

Nutrition: 12. How much water do you drink during a day? *

Nutrition: 13. Would you say your emotional state affects the way that you eat? *

Nutrition: 14. What areas of your diet do you think you face the greatest challenge? *

Digestion: 1. How frequent are your bowel movements? *

Digestion: 2. Do you experience any stomach acid reflux during or after meals? *

Lifestyle: 1. What is your occupation and how many hours do you work? *

Lifestyle: 2. What is your activity level at work? *

Lifestyle: 3. How would you perceive your level of stress? *

Lifestyle: 4. How often do you travel? *

Lifestyle: 5. How many late nights socially per week do you have? *

Lifestyle: 6. Do you have more energy in the morning or the evening? *

Lifestyle: 7. Do you have trouble switching off in the evening? *

Lifestyle: 8. Do you get a dip in energy in the afternoon? *

Lifestyle: 9. Relationship status? Children? *

Sleep: 1. Do you have trouble falling asleep at night? *

Sleep: 2. Do you have difficulty waking up in the morning? Do you use an alarm? *

Sleep: 3. Do you sleep less than 8 hours a night? *

Sleep: 4. Do you wake up once or more during the night? *

Sleep: 5. Do you sleep in a room with any light or noise? *

Sleep: 6. Do you go to bed later than 10pm? *

Sleep: 7. Do you get up earlier than 6am? *

Sleep: 8. Do you use medications (over the counter or prescription) to help you sleep? *

Sleep: 9. Do you currently take any health products or supplements? *