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*Name

*Email

*Phone number

*Date of Birth

Occupation

Working environmentOffice, outdoors, labour intensive, working from home, inner city, etc

Home environmentInner city, countryside, flat, garden, who do you live with, pets

Current weightor closest estimate

*Heightor closest estimate

*GP Name & Address

Tell me about you & why you want nutrition supportLet me know a little bit more about yourself

Have you worked with a Nutrition practitioner or followed any diets before?Please give as much info as possible!

Current health issuesDo you have (or recently have had) any diagnosed medical conditions/significant periods of illness you feel I should be aware of?

Current medicationsAre you currently taking any medications? Please specify name, brand and dose

Current supplements & herbal remediesAre you currently taking any supplements? Please specify name, brand and dose

Are you a smoker?If yes, how many a day on average?

Is there any history of illness in your current or immediate family?

Have any of the women in your family had any female health related problems?PCOS, Endometriosis, Fibroids, Infertility, difficulties conceiving, Ovarian cysts, ovarian cancer, etc

Is there anything else worth noting regarding your family history?

Lifestyle

How would you describe your daily activity level?Desk based job/active job etc

Your daily non gym activity level

Walking for 0-1 hour a day

Walking for 1-2 hours a day

Walking 2+ hours a day

How often do you train at Creature Fitness?

Once a week

1-2 times a week

2-3 times a week

3-4 times a week

4-5 times a week

Do you do any other exercise/sports outside of Creature Fitness?If so, please give details, how often, how long for etc

Do you ever rely on caffeine/sugar to get you through the day?

Mental Health

Have you ever suffered with mental health issues?

Have you ever been prescribed medication for mental health related illness?Please provide brand, name and duration

Is there any history of mental health related illness in your family?If applicable

Are you under significant stress or pressure?Home, work, relationships etc

How many people rely on you?Children, parents etc

Women's Health (Women only)

Are you pregnant?

Yes

If yes, how many weeks?

Are you trying to concieve?

Yes

If yes, what methods have you tried?

Are you breast feeding?

Yes

Do you have children?

Yes

If yes, how many and what are their ages?

What is your current method of contraception?If trying to conceive, leave blank

Are You Still Menstruating?

Yes

Do you know your average cycle length? From day 1 of your bleed, until the day before your next ie 28 days

Have you been on HRT?

Yes

If yes, how long for?

Are your periods regular?

Yes

Do you suffer with particular heavy or painful periods?

Yes

Please provide details

Men's Health (Men only)

Have you previously had children?

Yes

If yes, how many and when?

Are you aware of any history of testicular/prostate issues in your family?

Yes

Please provide details

Have you ever used anabolic steroids/similar enhancing drug?

Yes

Please provide details

Your Likes & Dislikes

Are there any foods that you really enjoy/consume regularly?for example chocolate or crisps

What are some of your favourite meals/foods?

What types of foods do you crave?and when do you crave them?

Are there any foods that you hate?

Are there any foods that you try to avoid?Why do you avoid them?

Drinks & Hydration

How much water do you typically drink in a day?an estimate is fine

How much caffeine do you consume in a day?Please provide type of drink including decaffeinated drinks

How much alcohol do you consume with in a week? including weekends

Ratings

With 1 being the lowest and 10 being the highest

Rate your Stress Levels

Rate your Energy Levels

Rate your Sex Drive

Rate your Motivation

Rate your Life Satisfaction

Weekly Food Diary

Please provide an example of your usual eating pattern including the time. Try to include some ‘normal’/ working days, and some weekend/days off. Please be as detailed as possible. As there any many ways of eating I haven’t headed the meals as ‘breakfast’ etc, just use the boxes to suit you. Include all/any snacks and all drinks.

Day 1

Day 2

Day 3

Day 4

Day 5

Thank You!

Click below to submit your forms, all of your information is secured. You will also receive a confirmation email.

Once you click submit you will automatically be taken to the Terms Of Engagement form that you need so sign electronically, a link to the form will also be in your email confirmation just incase.

Creature Fitness Nutrition Coaching

Lifestyle

Mental Health

Women's Health (Women only)

Men's Health (Men only)

Your Likes & Dislikes

Drinks & Hydration

Ratings

With 1 being the lowest and 10 being the highest

Weekly Food Diary

Thank You!

Click below to submit your forms, all of your information is secured. You will also receive a confirmation email.

Once you click submit you will automatically be taken to the Terms Of Engagement form that you need so sign electronically, a link to the form will also be in your email confirmation just incase.