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Take the NutriTest
1. Name
2. Age
3. Email
4. Phone Number
5. Height (in cm)
6. Weight
7. How many meals do you typically eat per day?
1
2
3
More than 3
8. How often do you consume fruits and vegetables?
Daily
A few times a week
Rarely
Never
9. Do you follow any specific diet (e.g., vegetarian, vegan, keto, etc.)? If yes, please specify:
10. How often do you consume dairy products?
Daily
A few times a week
Rarely
Never
11. How much water do you drink daily?
Less than 1 liter
1-2 liters
2-3 liters
More than 3 liters
12. How often do you consume sugary drinks (e.g., soda, juice)?
Daily
A few times a week
Rarely
Never
13. Do you consume caffeine (e.g., coffee, tea)? If yes, how many cups per day:
14. How many hours of sleep do you get on average per night?
Less than 5 hours
5-7 hours
7-9 hours
More than 9 hours
15. How often do you exercise?
Daily
A few times a week
Rarely
Never
16. What type of exercise do you typically engage in (e.g., walking, running, gym, yoga)?
17. Do you consume alcohol?
Yes, regularly
Occasionally
Rarely
Never
18. Do you smoke or use tobacco products?
Yes, regularly
Occasionally
Rarely
Never
19. Do you experience stress frequently?
Yes
No
20. Do you have any known food allergies or intolerances? If yes, please specify:
21. Have you been diagnosed with any chronic conditions (e.g., diabetes, thyroid issues, PCOD/PCOS, etc.)? If yes, please specify:
22. Do you experience frequent digestive issues (e.g., bloating, constipation, diarrhea)?
Yes
No
23. How often do you experience fatigue or low energy levels?
Daily
A few times a week
Rarely
Never
24. Do you have a family history of chronic illnesses (e.g., diabetes, heart disease)? If yes, please specify:
25. Do you experience frequent mood swings or irritability?
Yes
No
26. Do you take any dietary supplements? If yes, please specify:
27. Are you currently experiencing symptoms related to menopause (e.g., hot flashes, mood swings)?
Yes
No
28. Do you have any concerns about bone health (e.g., joint pain, osteoporosis)?
Yes
No
29. Are you currently breastfeeding or planning to breastfeed soon?
Yes
No
30. Do you often experience hangovers after consuming alcohol?
Yes
No
31. Do you have any thyroid-related symptoms (e.g., weight changes, fatigue)?
Yes
No
32. Do you experience symptoms related to PCOD/PCOS (e.g., irregular periods, acne, hair growth)?
Yes
No
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