Nutrition Assessment – Active Body Recovery

Section 1

About You

First Name *

Last Name *

Email Address *

Phone Number

Age *

Biological Sex *

Height *

Current Weight (lbs) *

Goal Weight (lbs)

Section 2

Goals & Motivation

What is your primary nutrition goal? *

Lose body fat Build muscle and strength Maintain weight and improve energy Improve gut health and digestion Support injury recovery Improve performance and endurance Manage a health condition

How long have you been working toward this goal?

Just starting A few months 1 to 2 years Several years

What would reaching this goal mean for your life? *

Be specific. The more honest you are here, the better I can build around your actual why.

Have you worked with a nutrition coach or followed a specific diet plan before?

No, this is new for me Yes, with a coach Yes, on my own

What has gotten in the way of your nutrition goals in the past?

Section 3

Current Eating Habits

How many meals do you typically eat per day?

1 to 2 3 4 to 5 I graze throughout the day It varies a lot

Do you eat breakfast?

Yes, every day Sometimes Rarely or never

How often do you eat out or order food?

Rarely, I mostly cook A few times a week Almost every day

Do you track your food intake?

Yes, consistently Sometimes No, I never track

How would you rate your eating consistency throughout the week?

Very consistent Mostly consistent Inconsistent Good weekdays, off on weekends

How much water do you drink daily?

Less than 4 cups 4 to 6 cups 6 to 8 cups More than 8 cups

Describe a typical day of eating for you

Section 4

Food Preferences & Restrictions

Do you follow any dietary approach?

No specific approach Vegetarian Vegan Pescatarian Keto or low carb Paleo Mediterranean Intermittent fasting Other

Do you have any food allergies? *

None Gluten / Wheat Dairy Tree nuts Peanuts Eggs Shellfish Soy

Any food intolerances or sensitivities?

Are there foods you simply do not like or refuse to eat?

I will work around your preferences, not force food on you.

What are some foods or meals you genuinely enjoy?

The best plan is one that includes food you actually want to eat.

How comfortable are you with meal prep?

I love meal prepping Some prep is fine I need quick and easy I barely cook

Section 5

Sleep & Stress

Sleep and stress directly affect hunger hormones, cravings, and how your body uses food. This section helps me build a plan that accounts for your real life, not an ideal version of it.

How many hours of sleep do you get on a typical night?

Less than 5 hrs 5 to 6 hrs 6 to 7 hrs 7 to 8 hrs More than 8 hrs

How would you rate your sleep quality?

Poor Fair Good Excellent

How would you describe your current stress level?

Low Moderate High Very high

Do you notice changes in your eating when stressed or sleep-deprived?

Yes, I eat more or crave junk Yes, I eat less or forget Not really

What does your daily activity level look like outside of exercise?

Mostly sedentary Lightly active Moderately active Very active

Section 6

Supplements, Alcohol & Caffeine

Do you currently take any supplements?

None Protein powder Creatine Multivitamin Vitamin D Omega-3 / Fish oil Probiotic Magnesium Pre-workout

Any other supplements not listed above?

How much caffeine do you consume daily?

None 1 cup coffee or tea 2 to 3 cups 4 or more cups Energy drinks daily

How often do you drink alcohol?

Never Occasionally Socially (1 to 2x a week) Regularly (most nights)

When you do drink, what is your typical amount?

1 drink 2 to 3 drinks 4 or more drinks N/A

Section 7

Final Notes

Are you currently working with any healthcare providers?

Are you taking any prescription medications that could affect appetite, metabolism, or weight?

Is there anything else you want me to know before I build your plan?

How did you find out about Active Body Recovery?

Ready to send it over.

I personally review every submission and will have your plan built and sent to your email within 24 to 48 hours. No automated responses. No templates.

Active Body Recovery – Mobile Personal Training

Your plan starts
with your story.

About You

Goals & Motivation

Current Eating Habits

Food Preferences & Restrictions

Sleep & Stress

Supplements, Alcohol & Caffeine

Final Notes

Ready to send it over.

Your plan startswith your story.

About You

Goals & Motivation

Current Eating Habits

Food Preferences & Restrictions

Sleep & Stress

Supplements, Alcohol & Caffeine

Final Notes

Ready to send it over.

Your plan starts
with your story.