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Vision Session Questionnaire
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Email
*
Your email
Name
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Your answer
Best contact number
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Your answer
Location
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Your answer
Age
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Your answer
Weight
Your answer
Height
Your answer
Have you ever worked with a nutrition coach before?
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Your answer
What are your main challenges surrounding your health/ nutrition right now?
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Your answer
What is your previous experience with nutrition or weight loss programs/ strategies?
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Your answer
What are the 3 main goals you want to achieve over the next 3 months?
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Your answer
What's stopped you from making changes in the past?
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Your answer
How would you feel if you achieved your goals?
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Your answer
Occupation
Your answer
Do you smoke?
Your answer
Do you drink alcohol?
Your answer
Daily caffeine intake
Your answer
Do you have any medical issues I need to be aware of?
Your answer
Any allergies?
Your answer
How many hours of sleep of you get per night?
Your answer
What are your sleep habits like?
Your answer
Occupation stress level
Low
Medium
High
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Home stress level
Low
Medium
High
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How would you rate your energy levels?
Low
Medium
High
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Do you sit or stand at work?
Your answer
Are you currently undergoing exercise and if so what is your routine?
Your answer
How many steps do you average per week?
Your answer
Do you have a nutrition goal? eg less processed foods, more protein, less sugar, more veggies etc
Your answer
Are you on any specific meal plans/ diets at the moment? Please explain
Your answer
Do you take any supplements or medications?
Your answer
What foods do you like?
Your answer
What foods do you dislike?
Your answer
Do you have knowledge or nutrition labels and macronutrients?
Your answer
Previous nutrition strategies/ experiences that weren't for you:
Your answer
Previous nutrition successes
Your answer
What is your standard day on a plate?
Your answer
Have you ever experienced any food restriction behaviours or food guilt?
Your answer
Do you have supportive family friends?
Your answer
Any other info you think I'd need to know?
Your answer
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