nutritionist berlin

Take 5 minutes to answer the questions before the appointment.

Email *
Name and surname *
DATE OF BIRTH *
Address *
where did you hear about me? *
why did you decide to contact a nutritionist? *
Have you already consulted a nutritionist in the past? *
have you tried any diet in the past? *
Fill required fields.

🍕 Your eating habits

What kind of meal plan are you looking for? *
what do you eat for breakfast? *
(describe as many options as possible with quantities)
What do you eat for lunch? *
(describe as many options as possible with quantities)
what do you eat for dinner? *
(describe as many options as possible with quantities)
do you have snacks? *
If yes, how many times during the day? What do you usually eat?
is there something you don't like? *
do you drink alcohol? *
do you order delivery food? *
what could be your main struggle while you're trying to achieve your goal? *
Fill required fields.


🏃‍♀️ your lifestyle

How active are you? *
How is your sleep? *
(select as many options as possible)
How is your energy during the day? *
Do you tend to eat out of boredom, stress, anger? *
Do you feel guilty if you eat too much? *
Do you check your weight on the scale? *
Do you check your body in front of the mirror? *
Fill required fields.


🚧 OBSTACLES TO YOUR GOAL

Help me understand what might be your struggles.

How your environment might interfere *
(select as many options as possible)
How your actual behaviors might interfere *
(select as many options as possible)
How your relationship with food/diets might interfere *
(select as many options as possible)
Do you think that carbs make you fat? *
After how long do you expect to see any results? *
What excites you about having or following a custom meal plan? *
Fill required fields.


🫀 YOUR HEALTH

When was the last time you had a blood test? Were the values normal? *
do you have any diagnosed intolerance? *
Intestinal regularity problems, reflux, aerophagia, bloating? *
Describe the condition or answer none
Do you have any of the following diagnoses?
FOR WOMEN (menstrual cycle)
Do you take supplements, vitamins, and proteins? *
Describe which ones or write none
Is there anything else about yourself that you would like to share with me to help in building your meal plan?
Fill required fields.