Client's Nutritional Questionaire
Menu
Home
About Us
Contact Us
Client Information
Our Services
Nutritional Questionnaire
Role Of Nutrition
Glyceamic Index
Metabolic Typing
Why Diets Don't Work
Articles
Terms & Conditions
Trainer Information
Our Services
Trainers Directory
Advanced search
Trainer's Info
Trainer Registration
Trainer Login
Client's Nutritional Questionaire
General Information
To get the most from this questionaire and for your analysis to be accurate, please be honest in your answers and don't try to second guess what you "should" be answering. There are no right and wrong answers!
You must agree to our terms and conditons to proceed with the questionaire.
First Name
*
Last Name
*
E-Mail
*
Verify E-Mail
Your Personal Trainer
*
Not Applicable
ActiveNRG
Adept Fitness
Andy Hayward
Anton Cooke
Ben Claypole
Body Active Personal Training Ltd
Dan Roberts
Darren Hughes
David Cannoans
Ella Jarvest
Energyburst Limited
Equilibrium
Fit 4 Action - Gareth Piggott
Fitasulike
Fitness Revolution Ltd
Glen Stokes
Greg Harmey
Healthchange
Jamie Lloyd Personal Training
kim stewart
Lila West
Magnus MacDonald
Matt Allen
Otium Lifestyle
Personal Power UK Ltd
Phoenix Exercise Professionals
Positive Fitness
Qi Health & Fitness
Richard Tyler
Rob Woollen
Sally Langdon
Samantha Stevens
Simon Finch - Fitness Consultants
Sophie Williams
Suzanne Parrott
The Feel Good Factor
Training 4 U
Agree to Terms & Conditons
*
Yes
Can we pass your E-Mail details to carefully selected 3rd parties?
*
Yes
No
Vital Statisitics
We need some basic information from you in order to undertake a more precise and targeted analysis of your information.
Gender
Enter your answer...
Male
Female
Age (in whole years)
Weight (state if in Kg, Lbs or Stones/Lbs)
Height (state if in m/cm or ft/ins)
Metabolic Profile
This section helps discover what metabolic type you are and which foods you best perform on, be it carbohydrate based or protein based or a mixed type.
A full explanation can be found under Metabolic Typing in the left hand side menu block.
Build
Enter your answer...
Thin Build
Average Build
Stocky Build
Face Shape
Enter your answer...
Angular Face
Round Face
Not Round or Angular
Ears
Enter your answer...
Pale Ears
Ruddy Ears
Neither Ruddy or Pale
Physical Activity
Enter your answer...
Prefer Long Distance Sports
Prefer Short Distance Sports (Sprint)
No Preference
Complexion
Enter your answer...
Pale Complexion
Ruddy Complexion
Not Ruddy or Pale
Please answer each of the questions and be as truthful as possible as your program will be based upon the information given.
It may be advisable to use a friend to help with some of the more subjective questions.
Metabolic Profile (contd.)
This section helps discover what metabolic type you are and which foods you best perform on, be it carbohydrate based or protein based or a mixed type.
A full explanation can be found under Metabolic Typing in the left hand side menu block.
Healing
Enter your answer...
Slow Healing
Fast Healing
Not Slow or Fast
Sleeping
Enter your answer...
Poor Sleeper
Good Sleeper
Mixed Sleeper
Waking
Enter your answer...
Wake Up Easily
Like to Sleep In
Mixed Waking Pattern
Body Temperature
Enter your answer...
Often Feel "Hot"
Often Feel "Cold"
Mixture
Urination
Enter your answer...
Infrequent
Frequent
Mixture
Eye & Mouth Moisture
Enter your answer...
Dry Eyes / Mouth
Moist Eyes / Mouth
Neither
Throat Moisture
Enter your answer...
Dry Throat
Phlegm In Throat
Neither
Please answer each of the questions and be as truthful as possible as your program will be based upon the information given.
It may be advisable to use a friend to help with some of the more subjective questions.
Metabolic Profile (General Health)
It is essential you are in the best health possible in order to reach your goals.
This section targets the 6 key areas of your health and the answers given will allow us to design a diet that can help get you in optimal health. A full explanation will come with the report.
Only tick if you know and agree with the question.
Complaints
Allergies
Asthma
Chronic Fatigue
Constipation
Diarrhoea
Heartburn
High Blood Pressure
Irregular Heartbeat
Migraines
Poor Digestion
Please be as truthful as possible as your program will be based upon the information given. It may be advisable to use a friend to help with some of the more subjective questions.
Metabolic Profile (Personality)
It is essential you are in the best health possible in order to reach your goals.
This section targets the 6 key areas of your health and the answers given will allow us to design a diet that can help get you in optimal health. A full explanation will come with the report.
Only tick if you know and agree with the question.
Tolerance
Enter your answer...
Irritable
Slow To Anger
Neither Or Both
Activity
Enter your answer...
Hyperactive
Deliberate / Cautious
Neither Or Both
Emotion
Enter your answer...
Emotionally Cool
Warm & Outgoing
Neither Or Both
Concentration
Enter your answer...
Excellent
Lethargic
Neither Or Both
Please be as truthful as possible as your program will be based upon the information given. It may be advisable to use a friend to help with some of the more subjective questions.
Metabolic Profile (Diet)
It is essential you are in the best health possible in order to reach your goals.
This section targets the 6 key areas of your health and the answers given will allow us to design a diet that can help get you in optimal health. A full explanation will come with the report.
Only tick if you know and agree with the question.
Appetite
Enter your answer...
Poor Appetite
Large Appetite
Average Appetite
Which food would you find hard to give up?
Sweets
Bread
Fruit
Pasta
Cereals
Meat
Salt
Fatty Foods
Eggs
Crisps
Please be as truthful as possible as your program will be based upon the information given. It may be advisable to use a friend to help with some of the more subjective questions.
Cardiovascular Profile
It is essential you are in the best health possible in order to reach your goals.
This section targets the 6 key areas of your health and the answers given will allow us to design a diet that can help get you in optimal health. A full explanation will come with the report.
Only tick if you know and agree with the question.
Blood Pressure Above 140/90?
Yes
Resting Pulse Over 75 bpm?
Yes
More than 14lb (6.3kg) Overweight?
Yes
Family History Of Heart Disease?
Yes
Eat Fried Food More Than 4 Times A Week?
Yes
Smoke More Than 5 Cigarettes Daily?
Yes
More Than 2 Alcoholic Drinks A Day?
Yes
Usually Add Salt To Food?
Yes
Please be as truthful as possible as your program will be based upon the information given. It may be advisable to use a friend to help with some of the more subjective questions.
Digestive Profile
It is essential you are in the best health possible in order to reach your goals.
This section targets the 6 key areas of your health and the answers given will allow us to design a diet that can help get you in optimal health. A full explanation will come with the report.
Only tick if you know and agree with the question.
Indigestion
Yes
Constipation or Diarrhoea
Yes
Mucus Or Undigested Food In Stools
Yes
Bloating Or Flatulance
Yes
Bad Breath
Yes
Still Feel Full 2 Hours After Eating
Yes
Take Digestion Tablets Or Remedy
Yes
Antibiotics Within Last 12 Months?
Yes
Please be as truthful as possible as your program will be based upon the information given. It may be advisable to use a friend to help with some of the more subjective questions.
Immune Profile
It is essential you are in the best health possible in order to reach your goals.
This section targets the 6 key areas of your health and the answers given will allow us to design a diet that can help get you in optimal health. A full explanation will come with the report.
Only tick if you know and agree with the question.
More Than 3 Hard To Shift Colds A Year
Yes
History Of Medication Or Recreational Drugs
Yes
Smoked 5 Or More Cigarettes A Day In Last 5 Years
Yes
Swollen Glands
Yes
Hayfever / Airborne Allergies
Yes
Food Intolerances
Yes
Dark Patches Under Eyes
Yes
Frequent Boils / Painful Spots
Yes
Please be as truthful as possible as your program will be based upon the information given. It may be advisable to use a friend to help with some of the more subjective questions.
Inflammatory Profile
It is essential you are in the best health possible in order to reach your goals.
This section targets the 6 key areas of your health and the answers given will allow us to design a diet that can help get you in optimal health. A full explanation will come with the report.
Only tick if you know and agree with the question.
Long Toes And Fingers
Yes
Ecxema Or Rashes
Yes
Recurring Joint problems
Yes
Muscular Pains
Yes
React Badly To Insect Bites
Yes
Often Short Tempered / Irritable
Yes
Drink More Than 3 Coffees / Teas Daily
Yes
Eat Red Meat / Dairy Foods Daily
Yes
Please be as truthful as possible as your program will be based upon the information given. It may be advisable to use a friend to help with some of the more subjective questions.
Blood Sugar Balance
It is essential you are in the best health possible in order to reach your goals.
This section targets the 6 key areas of your health and the answers given will allow us to design a diet that can help get you in optimal health. A full explanation will come with the report.
Only tick if you know and agree with the question.
Need More Than 8 Hours Sleep
Yes
Rarely Awake Within 20 Mins Of Rising?
Yes
Need Morning Stimulant (Tea/Coffee/Cigarette)
Yes
Excessive Thirst
Yes
Sudden Energy Dips (especially afternoon)
Yes
Dizzy / Irritable If Not Eaten
Yes
Often Difficult To Concentrate
Yes
Crave Sweet Foods
Yes
Please be as truthful as possible as your program will be based upon the information given. It may be advisable to use a friend to help with some of the more subjective questions.
Essential Fat Balance
It is essential you are in the best health possible in order to reach your goals.
This section targets the 6 key areas of your health and the answers given will allow us to design a diet that can help get you in optimal health. A full explanation will come with the report.
Only tick if you know and agree with the question.
Fried Foods More Than 4 Times A Week
Yes
Eat Margerine / Peanut Butter At Least 3 Times A Week
Yes
Suffer From Dry Eyes?
Yes
Suffer From Dry \ Rough Skin?
Yes
Poor Wound Healing
Yes
Please be as truthful as possible as your program will be based upon the information given. It may be advisable to use a friend to help with some of the more subjective questions.
Dietary Analysis
Detail any foods that you cannot or will not eat? Tell us about any special diets you follow, e.g. Vegetarian? Gluten Free?
Foods Not Eaten By Choice
Enter your answer here...
Foods You Cannot Eat (Bad Reaction)
Enter your answer here...
Please be as truthful as possible as your program will be based upon the information given. It may be advisable to use a friend to help with some of the more subjective questions.
Medical Conditions
Do you suffer from any diagnosed medical health issues? If so, for how long and what medication are you taking?
Medical Conditions
Please be as truthful as possible as your program will be based upon the information given. It may be advisable to use a friend to help with some of the more subjective questions.
Training Goals
Do you have any your specific training goals? If so please describe them here.
Training Goals
Please be as truthful as possible as your program will be based upon the information given. It may be advisable to use a friend to help with some of the more subjective questions.
7 Day Diet & Training Diary
We use this information as the starting point to your program. By looking at your existing diet in terms of your metabolic, health profiles and the training you are doing we can adapt and build on it where ever necessary in order to optimise your health and performance. Please answer as accurately and fully as possible.
You'll need details of your 7 day food intake and exercise programme...
The information needs to be as typical as possible as your dietary program will largely be based upon the information you give here.
For your Training / Exercise, include the time you started, the duration and the type of exercise you did. e.g.
06:30 - A few stretches then 3 mile run at conversational pace (25 minutes) then later (19:00) 20 mins on stair machine and 10 mins on some light weights in the gym.
For each meal include time, description, brands (if any) and approximate amounts... e.g.
Breakfast - 07:30
1 Cup of Tea, Bowl of Cornflakes and 2 rounds of White bread Toast.
Snack - 10:30
Mug of Hot chocolate & 2 digestive biscuits
Lunch - 13:00
Glass of Water (25cl) 1 Marks & Spencers Chicken Salad Sandwich, 1 standard size Mars Bar
Dinner 20:00
2 glasses (75cl) white wine, portion of mixed salad, portion of smoked mackrel in a home made creamy pasta sauce. 2 scoops Ben & Jerry's Vanilla ice cream. 1 Cup black coffee.
Please be as truthful as possible as your program will be based upon the information given. It may be advisable to use a friend to help with some of the more subjective questions.
Day 1 - Diet & Exercise
We use this information as the starting point to your program. By looking at your existing diet in terms of your metabolic, health profiles and the training you are doing we can adapt and build on it where ever necessary in order to optimise your health and performance. Please answer as accurately and fully as possible.
You'll need details of your 7 day food intake and exercise programme...
The information needs to be as typical as possible as your dietary program will largely be based upon the information you give here.
For your Training / Exercise, include the time you started, the duration and the type of exercise you did. e.g.
06:30 - A few stretches then 3 mile run at conversational pace (25 minutes) then later (19:00) 20 mins on stair machine and 10 mins on some light weights in the gym.
For each meal include time, description, brands (if any) and approximate amounts... e.g.
Breakfast - 07:30
1 Cup of Tea, Bowl of Cornflakes and 2 rounds of White bread Toast.
Snack - 10:30
Mug of Hot chocolate & 2 digestive biscuits
Lunch - 13:00
Glass of Water (25cl) 1 Marks & Spencers Chicken Salad Sandwich, 1 standard size Mars Bar
Dinner 20:00
2 glasses (75cl) white wine, portion of mixed salad, portion of smoked mackrel in a home made creamy pasta sauce. 2 scoops Ben & Jerry's Vanilla ice cream. 1 Cup black coffee.
Meals, Drinks & Snacks (Include times, brands and amounts...)
Supplements (Include brands, dosages and when taken...)
Training (Enter your training times, duration and type here...)
Please be as truthful as possible as your program will be based upon the information given. It may be advisable to use a friend to help with some of the more subjective questions.
Day 2 - Diet & Exercise
We use this information as the starting point to your program. By looking at your existing diet in terms of your metabolic, health profiles and the training you are doing we can adapt and build on it where ever necessary in order to optimise your health and performance. Please answer as accurately and fully as possible.
You'll need details of your 7 day food intake and exercise programme...
The information needs to be as typical as possible as your dietary program will largely be based upon the information you give here.
For your Training / Exercise, include the time you started, the duration and the type of exercise you did. e.g.
06:30 - A few stretches then 3 mile run at conversational pace (25 minutes) then later (19:00) 20 mins on stair machine and 10 mins on some light weights in the gym.
For each meal include time, description, brands (if any) and approximate amounts... e.g.
Breakfast - 07:30
1 Cup of Tea, Bowl of Cornflakes and 2 rounds of White bread Toast.
Snack - 10:30
Mug of Hot chocolate & 2 digestive biscuits
Lunch - 13:00
Glass of Water (25cl) 1 Marks & Spencers Chicken Salad Sandwich, 1 standard size Mars Bar
Dinner 20:00
2 glasses (75cl) white wine, portion of mixed salad, portion of smoked mackrel in a home made creamy pasta sauce. 2 scoops Ben & Jerry's Vanilla ice cream. 1 Cup black coffee.
Meals, Drinks & Snacks (Include times, brands and amounts...)
Supplements (Include brands, dosages and when taken...)
Training (Enter your training times, duration and type here...)
Please be as truthful as possible as your program will be based upon the information given. It may be advisable to use a friend to help with some of the more subjective questions.
Day 3 - Diet & Exercise
We use this information as the starting point to your program. By looking at your existing diet in terms of your metabolic, health profiles and the training you are doing we can adapt and build on it where ever necessary in order to optimise your health and performance. Please answer as accurately and fully as possible.
You'll need details of your 7 day food intake and exercise programme...
The information needs to be as typical as possible as your dietary program will largely be based upon the information you give here.
For your Training / Exercise, include the time you started, the duration and the type of exercise you did. e.g.
06:30 - A few stretches then 3 mile run at conversational pace (25 minutes) then later (19:00) 20 mins on stair machine and 10 mins on some light weights in the gym.
For each meal include time, description, brands (if any) and approximate amounts... e.g.
Breakfast - 07:30
1 Cup of Tea, Bowl of Cornflakes and 2 rounds of White bread Toast.
Snack - 10:30
Mug of Hot chocolate & 2 digestive biscuits
Lunch - 13:00
Glass of Water (25cl) 1 Marks & Spencers Chicken Salad Sandwich, 1 standard size Mars Bar
Dinner 20:00
2 glasses (75cl) white wine, portion of mixed salad, portion of smoked mackrel in a home made creamy pasta sauce. 2 scoops Ben & Jerry's Vanilla ice cream. 1 Cup black coffee.
Meals, Drinks & Snacks (Include times, brands and amounts...)
Supplements (Include brands, dosages and when taken...)
Training (Enter your training times, duration and type here...)
Please be as truthful as possible as your program will be based upon the information given. It may be advisable to use a friend to help with some of the more subjective questions.
Day 4 - Diet & Exercise
We use this information as the starting point to your program. By looking at your existing diet in terms of your metabolic, health profiles and the training you are doing we can adapt and build on it where ever necessary in order to optimise your health and performance. Please answer as accurately and fully as possible.
You'll need details of your 7 day food intake and exercise programme...
The information needs to be as typical as possible as your dietary program will largely be based upon the information you give here.
For your Training / Exercise, include the time you started, the duration and the type of exercise you did. e.g.
06:30 - A few stretches then 3 mile run at conversational pace (25 minutes) then later (19:00) 20 mins on stair machine and 10 mins on some light weights in the gym.
For each meal include time, description, brands (if any) and approximate amounts... e.g.
Breakfast - 07:30
1 Cup of Tea, Bowl of Cornflakes and 2 rounds of White bread Toast.
Snack - 10:30
Mug of Hot chocolate & 2 digestive biscuits
Lunch - 13:00
Glass of Water (25cl) 1 Marks & Spencers Chicken Salad Sandwich, 1 standard size Mars Bar
Dinner 20:00
2 glasses (75cl) white wine, portion of mixed salad, portion of smoked mackrel in a home made creamy pasta sauce. 2 scoops Ben & Jerry's Vanilla ice cream. 1 Cup black coffee.
Meals, Drinks & Snacks (Include times, brands and amounts...)
Supplements (Include brands, dosages and when taken...)
Training (Enter your training times, duration and type here...)
Please be as truthful as possible as your program will be based upon the information given. It may be advisable to use a friend to help with some of the more subjective questions.
Day 5 - Diet & Exercise
We use this information as the starting point to your program. By looking at your existing diet in terms of your metabolic, health profiles and the training you are doing we can adapt and build on it where ever necessary in order to optimise your health and performance. Please answer as accurately and fully as possible.
You'll need details of your 7 day food intake and exercise programme...
The information needs to be as typical as possible as your dietary program will largely be based upon the information you give here.
For your Training / Exercise, include the time you started, the duration and the type of exercise you did. e.g.
06:30 - A few stretches then 3 mile run at conversational pace (25 minutes) then later (19:00) 20 mins on stair machine and 10 mins on some light weights in the gym.
For each meal include time, description, brands (if any) and approximate amounts... e.g.
Breakfast - 07:30
1 Cup of Tea, Bowl of Cornflakes and 2 rounds of White bread Toast.
Snack - 10:30
Mug of Hot chocolate & 2 digestive biscuits
Lunch - 13:00
Glass of Water (25cl) 1 Marks & Spencers Chicken Salad Sandwich, 1 standard size Mars Bar
Dinner 20:00
2 glasses (75cl) white wine, portion of mixed salad, portion of smoked mackrel in a home made creamy pasta sauce. 2 scoops Ben & Jerry's Vanilla ice cream. 1 Cup black coffee.
Meals, Drinks & Snacks (Include times, brands and amounts...)
Supplements (Include brands, dosages and when taken...)
Training (Enter your training times, duration and type here...)
Please be as truthful as possible as your program will be based upon the information given. It may be advisable to use a friend to help with some of the more subjective questions.
Day 6 - Diet & Exercise
We use this information as the starting point to your program. By looking at your existing diet in terms of your metabolic, health profiles and the training you are doing we can adapt and build on it where ever necessary in order to optimise your health and performance. Please answer as accurately and fully as possible.
You'll need details of your 7 day food intake and exercise programme...
The information needs to be as typical as possible as your dietary program will largely be based upon the information you give here.
For your Training / Exercise, include the time you started, the duration and the type of exercise you did. e.g.
06:30 - A few stretches then 3 mile run at conversational pace (25 minutes) then later (19:00) 20 mins on stair machine and 10 mins on some light weights in the gym.
For each meal include time, description, brands (if any) and approximate amounts... e.g.
Breakfast - 07:30
1 Cup of Tea, Bowl of Cornflakes and 2 rounds of White bread Toast.
Snack - 10:30
Mug of Hot chocolate & 2 digestive biscuits
Lunch - 13:00
Glass of Water (25cl) 1 Marks & Spencers Chicken Salad Sandwich, 1 standard size Mars Bar
Dinner 20:00
2 glasses (75cl) white wine, portion of mixed salad, portion of smoked mackrel in a home made creamy pasta sauce. 2 scoops Ben & Jerry's Vanilla ice cream. 1 Cup black coffee.
Meals, Drinks & Snacks (Include times, brands and amounts...)
Supplements (Include brands, dosages and when taken...)
Training (Enter your training times, duration and type here...)
Please be as truthful as possible as your program will be based upon the information given. It may be advisable to use a friend to help with some of the more subjective questions.
Day 7 - Diet & Exercise
We use this information as the starting point to your program. By looking at your existing diet in terms of your metabolic, health profiles and the training you are doing we can adapt and build on it where ever necessary in order to optimise your health and performance. Please answer as accurately and fully as possible.
You'll need details of your 7 day food intake and exercise programme...
The information needs to be as typical as possible as your dietary program will largely be based upon the information you give here.
For your Training / Exercise, include the time you started, the duration and the type of exercise you did. e.g.
06:30 - A few stretches then 3 mile run at conversational pace (25 minutes) then later (19:00) 20 mins on stair machine and 10 mins on some light weights in the gym.
For each meal include time, description, brands (if any) and approximate amounts... e.g.
Breakfast - 07:30
1 Cup of Tea, Bowl of Cornflakes and 2 rounds of White bread Toast.
Snack - 10:30
Mug of Hot chocolate & 2 digestive biscuits
Lunch - 13:00
Glass of Water (25cl) 1 Marks & Spencers Chicken Salad Sandwich, 1 standard size Mars Bar
Dinner 20:00
2 glasses (75cl) white wine, portion of mixed salad, portion of smoked mackrel in a home made creamy pasta sauce. 2 scoops Ben & Jerry's Vanilla ice cream. 1 Cup black coffee.
Meals, Drinks & Snacks (Include times, brands and amounts...)
Supplements (Include brands, dosages and when taken...)
Training (Enter your training times, duration and type here...)
Please be as truthful as possible as your program will be based upon the information given. It may be advisable to use a friend to help with some of the more subjective questions.
Check, Then Submit Questionnaire
Before you click on "Submit Questionnaire", why not use the navigation buttons to check through all of your answers?
When you are sure you are satisfied, submit your questionaire.
Once you have submitted your questionaire you will NOT be able to go back and alter anything.
Please be as truthful as possible as your program will be based upon the information given. It may be advisable to use a friend to help with some of the more subjective questions.
Terms & Conditions
Help
New Trainers
Samantha Stevens
- Hull
(21-10-2007)
Adept Fitness
- London
Adept Fitness is a London based personal training
(24-03-2007)
Sally Langdon
- Orpington
(24-03-2007)
All Content © 2005-2009
PT Nutrition
All Rights Reserved. We do not disclose our Client's or Trainer's information to 3rd parties.
Terms and Conditions
