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Nutrition Client Survey

Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.

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1

What is your name?

Please provide your full name.
2

How old are you?

Please indicate your age in years.
3

What is your gender?

Please select your gender.
4

What is your weight?

Please indicate your weight in kilograms.
5

What is your height?

Please indicate your height in centimeters.
6

How many meals do you eat per day?

Please select the number of meals you typically have in a day.
7

What are your favorite foods?

Please list the foods that you enjoy eating the most.
8

What foods do you dislike?

Please list the foods that you prefer to avoid.
9

What are your dietary goals?

Please describe your objectives related to nutrition and health.
10

Do you have any other relevant information to share?

Feel free to add any additional details you consider important.