Get your Diet Plan – Balanced Bites By Neha

Health & Nutrition Assessment Questionnaire

Complete our detailed Health & Nutrition Assessment so we can design a diet plan tailored specifically to your body, lifestyle, and health goals.

Help us understand your health history, lifestyle, and goals so we can create a nutrition plan tailored just for you.

Full Name

Whatsapp Number

Age

Gender

Height

Weight

Have you followed a specific diet before?

Primary Goal

Are you allergic to any food items?

Any other disease or medical condition?

Dietary Habits & Daily Routine Please list the food items you consume most frequently or on a daily basis:

Morning

Breakfast

Lunch (Food list)

Evening Snack (Food list)

Dinner (Food list)

Additions to any food/drink (e.g., sugar, condiments)

Glasses of water per day

Number of days you workout per week

Have you had any recent blood work done?

Are you taking any medicine on a daily basis?

Complete this quick assessment so we can create a nutrition plan tailored specifically to your body and goals.

Every body is different. A successful nutrition plan starts with understanding you.