Form | Dr Fitness and Nutrition

Name *

Email address *

Gender *

Male
Female
Rather not say

Height (cm) *

Weight (kg) *

Please tell me what your goals are. Break these into Short (Up to 3 months), medium (3-9 months) and long (9-12 months) term. *

How often do you prepare your own meals from scratch? *

Never
Hardly Ever
Often
Most of the time

How often do you eat/drink junk food, such as fizzy drink, takeaway, sweets, crisps etc? *

Never
Hardly Ever
Often
Most of the time

Do You Smoke *

Yes
No

How many units of alcohol do you drink a week? *

I don't drink
0-8
8-14
14-20
20-25
25+

Do you have any dietary needs? *

Vegan
Vegetarian
Pescatarian
GF
Other
None

Please write any food you don't like *

Please write the foods you love *

Are you willing to share before and after pictures? *

Yes
No