CN Nutrition Analysis

Client's name:(required)

Gender:(required)
MALEFEMALE

Age:(required)

Date of Birth:(required)

Height:(required)

Weight:(required)

Given the following goals, please rank them in order of importance,
with 1 being the most important and 8 being the least important.

Improved health:(required)
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Increased muscle mass: (required)
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Improved endurance: (required)
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Fat loss:(required)
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Increased strength:(required)
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Increased power:(required)
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Sport specific*: (required)
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Weight gain: (required)
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Are you currently exercising at least 3 days a week? (required)

How long have you been consistently exercising without a break? (required)

On a typical week, how often do you lift weights? (required)

When weight lifting, would you say you work with light, moderate, or heavy weights? (required)

How would you rank your muscle recovery rate measured by perceived muscle soreness from training sessions on a scale of 1 to 10? (10 being very sore) (required)

On a typical week, how often do you incorporate cardio sessions? (required)

What do you do for a living? (required)

What is the activity level at your job? (required)
NONE (SEATED WORK ONLY)MODERATE (LIGHT ACTIVITY SUCH AS WALKING)HIGH (HEAVY LABOUR VERY ACTIVE)

What are your stress levels like on a day to day basis? Think both work and home. (required)

If you answered yes to stressed, what are you currently doing to manage this stress?

Do you consume alcohol on a weekly basis? If so, how many servings? (required)

Are you, or have you been a habitual smoker in your life time? (required)

How much water do you consume daily? (required)

How often do you travel? (required)
RARELYFEW TIMES A YEARFEW TIMES A MONTHWEEKLY

What are your energy levels like on a day to day basis? (required)

How many meals do you eat in restaurants and/or fast food places per week? (required)

If you have any known food allergies, please list them below:

Are there any other foods to which you are particularly sensitive (I.e., which cause excessive gas, bloating, stuffiness, or congestion)?

How well do you feel your digestion is? (required)

What is your memory and concentration like? (required)

How would you rank your neurological recovery (the brain) measured by mental fatigue or fogginess on a scale of 1 to 10? (10 being very foggy) (required)

What are your joints like? Do you have any stiffness in the mornings? (required)

Please provide a 3-day dietary record in the box below. Be sure that these records are representative of the last few months of your dietary intake. In other words, if you just decided to get in shape two weeks ago and changed your diet dramatically, you should give us an indication of how you had been eating habitually prior to the recent change. (required)

What time do you eat each of your meals and/or snacks? (required)

If there is any other information you think might be relevant to your program design, please share it with me below.

Do you have trouble falling asleep at night? (required)

Do you have difficulty waking up in the morning? (required)

Do you sleep less than 8-9hrs a night? (required)

Do you wake up once or more during the night? (required)

Do you sleep in a room with any light or noise? (required)

Do you wake up feeling tired? (required)

Do you use medications (OTC or Rx) for sleep? (required)