Team Mel: Nutrition & Lifestyle Intake Form

Your Nutrition Plan has to Work in Your Real Life.

I don't need you to eat like a fitness robot.

I want to understand what you enjoy eating, what your normal life looks like, where nutrition becomes difficult and what parts of your lifestyle matter enough that we should intentionally protect them.

How would you describe your current approach to nutrition?

I track calories and macros consistently

I follow a meal plan

I eat mostly intuitively

I try to eat healthy but no set structure

My nutrition feels inconsistent or chaotic

Walk me through what a typical weekday of eating currently looks like.

How does your nutrition usually differ on weekends?

What foods and meals do you genuinely enjoy eating?

Are there any foods you dislike or prefer not to eat?

Please list any food allergies or intolerances. If none, enter N/A.

Do any of the following apply to you?

Religious or cultural considerations

Food allergies / intolerances / Medical

Are there family meals, cultural foods or traditions that are important for us to work around or include?

Who prepares most of the food in your household?

Shared between household members

Parent / family member

Restaurant / takeout food makes up a significant portion

Who else lives in your household, and how does that affect your food choices or meal planning?

How often do you currently eat restaurant food or takeout?

About once per week

2–3 times per week

It varies significantly

How often do you currently drink alcohol?

Less than once per week

About once per week

2–3 days per week

Which days or situations tend to make nutrition harder for you?

What usually happens right before you overeat, snack more than planned or go off track?

When do you find nutrition most difficult?

Weekends and/or Evenings

Emotional Eating / Stress

Restaurants / Social Events

PMS / Menstrual Cycle

Team Mel: Nutrition & Lifestyle Intake Form

Today's Date

Full Name

Email address

How would you describe your current approach to nutrition?

Walk me through what a typical weekday of eating currently looks like.

How does your nutrition usually differ on weekends?

What foods and meals do you genuinely enjoy eating?

Are there any foods you dislike or prefer not to eat?

Please list any food allergies or intolerances. If none, enter N/A.

Do any of the following apply to you?

Are there family meals, cultural foods or traditions that are important for us to work around or include?

Who prepares most of the food in your household?

Who else lives in your household, and how does that affect your food choices or meal planning?

How often do you currently eat restaurant food or takeout?

How often do you currently drink alcohol?

Which days or situations tend to make nutrition harder for you?

What usually happens right before you overeat, snack more than planned or go off track?

When do you find nutrition most difficult?

What foods, meals or routines would you really like to keep in your nutrition plan?

What nutrition approaches have you tried in the past, and what worked or did not work?

Have you ever struggled with excessive restriction, binge eating, purging or another difficult relationship with food?

If yes or unsure, please share anything you feel comfortable telling me so I can coach you appropriately. If none, enter N/A.

On a scale of 1–10, how confident do you currently feel about managing your nutrition?

What is the biggest nutrition challenge you would like coaching support with?

Is there anything else you want me to know about your nutrition, lifestyle or relationship with food?