Nutrition Form — Big Goat Fitness

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Medical diagnoses or conditions

(e.g. diabetes, asthma, heart issues)

Medications or supplements taken regularly

Please list all below (e.g. blood pressure medication, creatine, magnesium, etc.)

Do you have any food allergies, sensitivities, or intolerances?

Please list all below

Do you have any current or past eating disorders we should consider in creating your plan?

(e.g. anorexia, bulimia, binge-eating disorder)

What diets or eating styles have you tried in the past?

Examples: Keto, Paleo, Vegan, Intermittent Fasting, etc.

Which diets or approaches have worked well for you, and why?

Which diets or approaches have not worked well for you, and why?

How would you describe your current eating habits?

What is your relationship with food like?

(e.g., emotional eating, stress eating, etc.)

Anything else?

Let’s get fit!