Health & Nutrition Assessment

Basic Info

Full Name: Age: Gender: Select Male Female Other Height: Current Weight: Goal Weight: Primary Health Goal: Select Fat Loss Muscle Gain Hormone Balance General Health

Medical & Hormonal Background

Do you have any diagnosed conditions? Are you currently on HRT, thyroid meds, or other hormone-related treatments? Any known food allergies or intolerances? Do you experience bloating, fatigue, headaches, or mood swings regularly? Are you currently pregnant, breastfeeding, or postpartum?

Nutrition Habits

How many meals do you eat per day? Select 1 2 3 4 5 6+ Do you snack between meals? What time is your first meal of the day? What time is your last meal of the day? Do you follow any dietary preferences? Any cultural or religious food restrictions?

Activity & Lifestyle

What’s your current activity level? What type of exercise do you do? What time of day do you usually work out? Select Morning Afternoon Evening Varies How many hours of sleep do you get per night? Select Less than 5 hours 5-6 7-8 More than 8 hours Do you work night shifts or have an irregular schedule?

Food Access & Prep

Do you cook most of your meals at home? Do you have access to a microwave, stove, or meal prep space? How many days per week can you realistically prep meals? Select 0 1 2 3 4 5 6 7 Do you shop weekly, biweekly, or monthly? Select Weekly Biweekly Monthly Any budget constraints or preferred stores?

Preferences & Motivation

What foods do you love and want included? What foods do you dislike or want excluded? What motivates you most? What’s one thing you’ve struggled with in past meal plans?