Pre-Consultation Report Phone First Name * Last Name * Address Street Address 1 City Country Post Code Mobile Number * Email * Sex Male Female Date of Birth Current Weight Please input Stones and Pounds Height Please input Feet & Inches What is your occupation? How physical is your occupation? Very Not very Not at all How would you rate your general daily activity (excluding exercise sessions) Sedentary (desk based, very little activity) Mildly active (3-5k steps) Active (5-10k steps) Very Active (10k plus steps) Your Personal goals What are your personal goals? Please provide as much information as possible. If we end up working together, what does success look like to you in 3 months, 6 months and 12 months? 3 Months Description 6 Months Description 12 Months Description Your current diet How many meals per day do you eat on average? Please write down a typical days food and drink in the mealtime sections below Remember to be honest with your answers What do you normally eat for a typical days breakfast ? What do you normally eat for a typical days lunch? What do you normally eat for a typical days dinner? What type of snacks do you usually eat on a typical day? What is your typical weekly alcoholic intake? (Be honest) Do you use any supplements or take any medication? Yes No If you have answered YES please list them below and include Brand, strength and quantities taken If you have taken any supplements or medication in the last 12 months, please provide detials. Include any you are no longer taking. Do you have any known food allergies? Yes No If YES please provide details Do you have any diet preferences eg; Vegan / vegetarian / gluten free Yes No If YES please provide detail Exercise & Training Do you currently participate in any exercise or sporting activities Yes No How often do you exercise in a typical week? Once a week 2-3 times a week 4-6 times a week Daily None Other What type of activity do you usually do Cardio Strength Both None What is a typical duration of your training sessions? General Do you have access to any of the following should your consultations need to be remote? Skype Facetime Messenger Zoom Other Support In simple and practical terms, what do you feel that you need to support you in terms of achieving your personal goals? If you chose to work with Transformational Nutrition to achieve your personal goals which elements of the service would you be interested in? Personal One to One consultation Personal one to one consultation with weekly coaching Personalised Recipes Premium service (all of above plus cooking & shopping support) Food diary analysis I confirm that I am happy for you to evaluate my submitted information for nutrition, weight and health purposes. I confirm that I am happy for you to send me specific feedback and information based on your professional business experience. I am happy to receive other information about the services of Transformational Nutrition by email, text message or social media messaging. This includes the likes of Facebook Messenger, What’s App, Telegram and in the Transformational Nutrition Facebook Groups that I may choose to use participate in * I Agree 6 month nutrition programme Start to create a healthy relationship with food and overcome emotional eatingSign up below to find out more about my amazing new group programme.Invalid email address We promise not to spam you. You can unsubscribe at any time.Thanks for subscribing! Please check your email for further instructions.