Nutrition Coaching Client Assessment Form
Personal Information
Full Name
Date of Birth
Email
Phone Number
Address
Health Information
Height (cm)
Weight (kg)
Gender
Male
Female
Non-binary
Prefer not to say
Occupation
Do you have any known medical conditions or allergies?
Are you currently taking any medication or supplements?
Goals
What are your main nutrition and health goals?
What challenges have you experienced with nutrition?
Lifestyle & Habits
Describe your typical daily activity level:
Sedentary
Lightly Active
Moderately Active
Very Active
Athlete
How many hours of sleep do you get per night on average?
Describe a typical day’s meals and snacks:
Additional Information
Is there anything else you’d like to share?