Diabetic Meal Planning Questionnaire
Full Name
Age
Email
Type of Diabetes
Type 1
Type 2
Gestational
Other
Height (cm)
Weight (kg)
Target Blood Glucose Range (mg/dL)
Daily Carbohydrate Intake Goal (grams)
Number of Meals per Day
Number of Snacks per Day
Food Allergies or Restrictions
Foods You Dislike
Current Medications (including insulin)
Physical Activity Level
Sedentary
Light Activity
Moderate Activity
High Activity
Main Nutrition & Meal Planning Goals
Other Notes