New Wave Fitness

CN Nutrition Analysis

Comprehensive Client Nutrition Analysis


This is your comprehensive nutrition analysis sheet, in which we will ask you to provide some relevant personal information. The answers to these questions are essential in order to allow us to design an optimized individual nutrition plan for you. Please answer all questions in the most accurate manner possible while being as concise as possible.


    Client's name:(required)



    Date of Birth:(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)

    Increased muscle mass: (required)

    Improved endurance: (required)

    Fat loss:(required)

    Increased strength:(required)

    Increased power:(required)

    Sport specific*: (required)

    Weight gain: (required)

    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)

    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)

    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)

    TERMS AND CONDITIONS:I hereby give my consent to allow New Wave Fitness, Inc. fitness professionals to design a nutrition program for me to enhance my health and fitness goals. I will follow that program to the best of my ability and I will not hold New Wave Fitness, Inc. or any related persons or parties personally liable for any problems, illnesses or injuries that might occur due to a change in my eating or exercise habits. I understand that New Wave Fitness, Inc. and any related persons or parties are not medical practitioners. Consult your medical doctor before making any changes to your nutrition and supplement program. This nutrition program does not replace the expert advice or medical treatment of my own private physician. I have given New Wave Fitness, Inc. all necessary information about myself to prevent any possible complications. I assume full responsibility for any risks, damages and losses arising out of my participation in the nutrition plan, whether caused by the negligence of Releasees or otherwise. I release, waive, and fully discharge New Wave Fitness, Inc., its directors, officers, agents, independent contractors, and employees (collectively, “Releasees”) from all liability for any and all loss or damage arising out of or related to the nutrition plan, whether caused by the negligence of Releasees or otherwise.

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