The questionnaire is designed to provide your nutritionist with the information necessary to build a nutritional
programme specifically tailored to your needs. Please answer the questions as accurately as you can.
This questionnaire consists of 4 pages and requires several minutes to fill in. If submitting online, you must be able to do so in one go, in which case you may fill in your food intake (on last page) for any 2 recent days.
Should you prefer to complete the questionnaire by hand and send it to us by post, the word document file can be downloaded here.
Fields marked with * are required.
Please list all the problems you would like to clear up and indicate for how long you have had these problems eg: depression 3 years