Intake form

Name *

Email address *

What is your age group?

What are your primary health goals?

Please select at least one option.

Weight loss

Muscle gain

Improved energy

Better digestion

Disease prevention

Overall wellness

Do you have any known dietary restrictions?

Please select at least one option.

Gluten-free

Dairy-free

Nut-free

Vegetarian

Vegan

Paleo

Ketogenic

None

What types of foods do you prefer?

Please select at least one option.

Fruits

Vegetables

Whole grains

Proteins

Dairy

Healthy fats

None

How often do you exercise?

What is your current level of knowledge about nutrition?

Have you previously used any nutrition apps or services?

If yes, please specify which ones.

Additional questions or comments

Please confirm that you are not a robot.

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