Health
Dieta
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Create Your Nutrition Profile
We need this information so our dietitian can prepare a personalized plan for you.
1
Basic Information
2
Goals
3
Health Status
4
Food Preferences
Basic Information
Full Name *
This field is required.
Age *
This field is required.
Gender *
♂ Male
♀ Female
Height (cm) *
This field is required.
Weight (kg) *
This field is required.
Target Weight (kg)
form.occupation_type *
🖥️
form.occ_office
🧑🏫
form.occ_standing
🏗️
form.occ_physical
form.sleep_hours
form.sleep_lt6
form.sleep_6_7
form.sleep_7_8
form.sleep_gt8
form.water_intake
form.water_lt1
form.water_1_2
form.water_2_3
form.water_gt3
Goals
What is Your Goal? *
🔽
Lose weight
🔼
Gain weight
💪
Maintain fitness
🥗
Eat healthy
🏋️
form.goal_muscle
form.goal_timeline *
form.timeline_1m
form.timeline_3m
form.timeline_6m
form.timeline_1y
Activity Level *
🛋️
Sedentary (desk job)
🚶
Lightly active (1-2x/week)
🏃
Moderately active (3-4x/week)
🏋️
Very active (daily exercise)
form.exercise_type
Health Status
form.chronic_title
form.chronic_note
form.chronic_diabetes2
form.chronic_hypertension
form.chronic_cholesterol
form.chronic_hypothyroid
form.chronic_hyperthyroid
form.chronic_celiac
form.chronic_reflux
form.chronic_ibs
form.chronic_pcos
form.uses_medication
form.medication_yes
form.medication_no
form.stress_level
form.stress_low
form.stress_mid
form.stress_high
form.stress_very_high
form.pregnancy_status
form.pregnancy_none
form.pregnancy_pregnant
form.pregnancy_breastfeed
Chronic Conditions
Doctor's Dietary Restrictions
Food Preferences
Diet Type *
🍖
Normal (everything)
🥬
Vegetarian
🌱
Vegan
🐟
form.diet_pescatarian
🥑
form.diet_keto
Allergies / Intolerances
Foods You Dislike
form.meal_frequency
form.meals_2
form.meals_3
form.meals_4_5
form.breakfast_habit
form.breakfast_always
form.breakfast_sometimes
form.breakfast_never
form.cooking_time
form.cook_fast
form.cook_medium
form.cook_long
form.snack_habit
form.snack_yes
form.snack_sometimes
form.snack_no
form.cuisine_pref
form.cuisine_turkish
form.cuisine_mediterranean
form.cuisine_asian
form.cuisine_western
form.cuisine_all
Daily Food Budget
Budget (under $5)
Medium ($5-10)
Premium ($10+)
Who is the Plan For?
👤 Just me
👨👩👧 My family (2+ people)
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