top of page

with Seak Nutrition Solutions

Home
About Us
Services
A Healthier You
Supplements
Contact Us
Shop
Gift Card
More

Use tab to navigate through the menu items.

Client Questionnaire

Client Questionnaire

1. Personal Information

First name*

Last name*

Email*

Phone*

Age*

Gender:*

Height:*

Weight:*

2. Current Lifestyle

Occupation:*

Type of Exercise and Frequency:*

Cardio (e.g., running, cycling)

Strength Training (e.g., weights, bodyweight exercises)

Other Exercise (e.g., yoga, swimming)

Daily Activity Level*

Sedentary (little to no exercise)

Lightly Active (light exercise or sports 1-3 days/week)

Moderately Active (moderate exercise or sports 3-5 days/week)

Very Active (hard exercise or sports 6-7 days/week)

3. Dietary Preferences

Dietary Restrictions or Allergies: (If yes, please provide details)

Special Dietary Preferences:

Vegetarian

Vegan

Gluten-Free

Dairy-Free

Other (please specify)

Disclaimer: Please note that meals are created based on the preferences you provide. If specific dislikes or restrictions are not mentioned in advance, meals will not be redone. Thank you for your understanding!

Please indicate any foods you dislike or avoid from the lists below:

Vegetables

Spinach

Broccoli

Cauliflower

Bell Peppers

Carrots

Others:

Fruits

Bananas

Apples

Grapes

Strawberries

Oranges

Others:

Grains

Wheat

Rice

Quinoa

Oats

Barley

Others:

Proteins

Chicken

Beef

Fish

Eggs

Tofu

Others:

Dairy

Milk

Cheese

Yogurt

Butter

Others:

Any Other Foods You Dislike or Cannot Eat: (Be Detailed / Specific)

4. Health Goals

Primary Goals for this Meal Plan:

Weight Loss

Muscle Gain

Weight Maintenance

Improved Performance

Other (please specify)

Specific Target Weight or Body Composition Goals (if applicable):

5. Current Eating Habits

How Many Meals Do You Typically Eat in a Day?

Do You Snack Between Meals? (If yes, what do you usually snack on?)

Typical Beverage Consumption:

Water

(approximate amount per day):

Coffee/Tea

(approximate amount per day):

Soft Drinks/Juices

(approximate amount per day):

Alcohol

(approximate amount per day):

Do you eat out or order takeout frequently? (If yes, how often per week?)

6. Nutritional History

Are You Currently Tracking Your Calorie or Macro Intake? (If yes, how do you track—e.g., MyFitnessPal, manual tracking, etc.?)

Current Macro Targets (if applicable)

Calories:

Protein:

Carbohydrates:

Fats:

Have you worked with a nutritionist or dietitian before? (If yes, please briefly describe your experience)

7. Meal Preparation and Preferences

How Much Time Are You Willing to Dedicate to Meal Preparation?

Less than 1 hour per week

1-3 hours per week

More than 3 hours per week

Do You Have Access to a Full Kitchen and Cooking Equipment?

Yes

No

Do You Have a Food Scale?

Yes

No

Preferred Meal Prep Style:

Single servings, ready-to-eat meals

Bulk cooking for multiple servings

Freshly prepared daily

Is There Anything Else You’d Like Us to Know? (Any specific preferences, health concerns, lifestyle factors, or other considerations)

Stay Connected

First Name*

Last Name*

Email*

Yes, subscribe me to your newsletter.

Phone

(707) 845 - 8827

Address

Millville, CA

Serving Clients Virtually

Follow

Email

info@seaknutritionsolutions.com

© 2024 by SEAK Nutrition Solutions, LLC. All Rights Reserved.

Designed by Divine Flow Digital LLC

Privacy Policy | Accessibility Statement | Terms & Conditions |

bottom of page