Initial Nutrition Assessment

Name*
First Last
Email*
What is your main goal?*
- Fat Loss
- Muscle Gain
- Improved health
What approaches have you tried so far?*
Which have been the most effective?*
How did you determine their effectiveness?*
How many meals a day do you normally eat?*
- Less than 3 a day
- Between 3-5 a day
- More than 5 a day
Do you normally have breakfast?*
- Yes
- No
Do you know on average how many calories you consume on a daily basis?*
- Yes
- No
How much plain/pure water do you consume on a daily basis?*
- Less than 1.5l a day
- Between 1.5-2.5l a day
- More than 2.5l a day
How many servings of vegetables do you consume a day?*
- Less than 4 a day
- Between 4-6 a day
- More than 6 a day
How active are you on a daily basis?*
- Very active
- Quite active
- Not very active
- Mostly sedentary
What time do you go to sleep each night?*
What time do you wake up each morning?*
Do you have any food allergies, intolerances or sensitivities?*
- Yes
- No
Please provide details*
Do you suffer from any dietary medical conditions (IBS, SIBO, Crohns, Coeliac, etc)?*
- Yes
- No
Please provide details*
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About The Company

Resilience Fitness was founded to help people achieve optimal well-being through individualized exercise and nutrition. The service is bespoke and personal, with no two people coached the same way. My goal is to build a better future for my clients and the people most important to them.

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If you're interested in working with me, want more information on my services or simply have a question that you think I might be able to answer, then get in touch using the form below. I'd love to hear from you.
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