Laforce Performance - Nutrition Assessment

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Personal Details

Basic information about you

First Name *

Last Name *

Email Address *

Phone Number

Date of Birth *

Gender

Occupation / Lifestyle Type

Sedentary (desk job) Lightly active Moderately active Very active (manual work)

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Body Measurements

Current and target data

Height

cm

Current Weight

kg

Goal Weight

kg

Waist Circumference (if known)

cm

Body Composition Goal

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Health & Medical History

Conditions, medications, and history

Other medical conditions not listed above

Current medications or supplements

Any recent blood work or test results?

Yes – I can share them Yes – but unavailable No

Currently pregnant or breastfeeding?

No Pregnant Breastfeeding Not applicable

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Dietary Preferences & Restrictions

Allergies, intolerances, and food choices

Foods you strongly dislike or avoid

Do you consume alcohol?

Daily caffeine intake

None 1 cup/day 2–3 cups/day 4+ cups/day

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Eating Habits & Patterns

Typical daily intake and behaviours

Meals per day?

Do you eat snacks?

Describe a typical day of eating

Daily water intake

< 1L 1–2L 2–3L > 3L

Do you eat out or order takeaway?

Rarely 1–2× per week 3–4× per week Almost daily

Do you experience emotional or stress eating?

Never Occasionally Frequently Almost always

Do you cook your own meals?

Always Mostly Sometimes Rarely

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Physical Activity

Exercise habits and energy expenditure

Exercise frequency

Average session duration

Nutrition around exercise

Pre-workout meal/snack Post-workout meal/snack Protein shake post-workout I train fasted

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Sleep & Stress

Lifestyle factors affecting nutrition

Average hours of sleep per night

< 5 hrs 5–6 hrs 7–8 hrs > 9 hrs

Current stress level (1–10)

Very lowVery high

How often do you feel fatigued during the day?

Rarely Sometimes Often Almost always

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Goals & Motivation

What you want to achieve

Primary nutrition goal *

Motivation to make dietary changes (1–10)

Not motivatedExtremely motivated

What has prevented you from reaching your goals in the past?

Anything else you'd like your coach to know?

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Consent & Declaration

Review and sign below

I confirm that the information provided in this questionnaire is accurate and complete to the best of my knowledge.

I understand that the nutrition plan provided is not a substitute for medical advice, and I have consulted or will consult my GP regarding any medical conditions.

I consent to my data being stored securely and used solely for the purpose of creating my personalised nutrition plan.

Client Signature *

Draw your signature below using your mouse or finger.

Date *

Nutrition Assessment
Questionnaire

Submitted!

Nutrition AssessmentQuestionnaire

Submitted!

Nutrition Assessment
Questionnaire