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Hi! Welcome to Nutricoach!

We are happy to help you with your nutritional goal!

Can you tell us your name?

Hi !

We are really excited to know you better!

Can you tell us more about you?

Contact number

Birthdate

Sex assigned at birth

How do you like spending your free time? (Select all that apply)

Doing physical activities Spending time with family Going out with friends Spending alone time at home I don`t have much of a free time

What challenges do you face in maintaining diet and exercise consistency? (Select all that apply)

Demanding work schedule Frequent Social Invitations Travel Obligations Lack of Discipline

When was the last time you consulted with a Nutritionist-Dietitian?

Years Ago Months Ago Weeks Ago Haven`t tried at all

How do you feel about having a nutritionist- dietitian guide you in managing your Nutrition?

Excited Indifferent Anxious Curious

Other

How much will you be willing to pay for a one-month subscription on Nutricoach?

5-10 USD 10-15 USD 20-30 USD

Metric Imperial

What's your height?

Eg. 170 cm

What's your weight?

Eg. 90 kg

Your BMI is approximately

you're within category

Your ideal body weight based on your height is kg

Is this also your goal weight?

Yes No

What's your goal weight?

Based on Mayo Clinic, the ideal recommended healthy weight loss is 0.5kg per week.

Weight Target kg

Are you diagnosed with hypertension?

Yes

What is your latest blood pressure reading?

Systolic

Diastolic

Date test taken

Testing time

Haven't taken your blood pressure yet? You may skip this process!

What is your latest blood sugar reading?

Blood sugar level

Date test taken

Testing time

Haven't taken your blood sugar test yet? You may skip this process!

Do you have any food allergies?

None Celery Crabs Dairy Eggs Fish (All types) Garlic Gluten Lobster Mustard Rice Sesame Shrimp Soy Tree Nuts (Almond, Walnuts etc) Wheat

Other

How often do you eat fast food or takeout?

Almost everyday

About once a week

Rarely or never

How many servings of fruits and vegetables do you consume daily?

1-2 Servings

3-5 Servings

Rarely or never

Do you consume any sugar-sweetened beverages (eg soda, juice, milk tea)?

Almost everyday

About once a week

Rarely or never

How often do you think about making change to your diet?

Frequently

Occasionally

Rarely or never

Have you set specific goals for improving your diet?

Yes, and I am working towards them.

I have some vague ideas but no specific goals yet.

No, I haven't set any goals.

How often do you plan your meals in advance?

Frequently

Occasionally

Rarely or never

Do you consume alcohol?

None at all

Occasionally

Monthly

More often

How often do you find yourself skipping meals?

Never

Once a week

Two or three times a week

Always

Do you feel good when you skip meals?

Yes, I feel lighter.

No, not really.

Do you know about the possible health risks if adjustments to a diet are not considered for a person diagnosed with diabetes?

Yes, I am fully aware

I have some knowledge, but not fully aware

No, I haven't looked into it

How many meals do you have per day (including snacks)?

1-2 meals

3-4 meals

5 or more meals

How often do you use a food diary to track your food intake?

Always

Often

Sometimes

Rarely or never

Are you under any stress or emotional distress?

Yes

How often do you eat due to stress or emotional reasons (eg boredom, anxiety, depression, work stress, etc.)?

Always

Often

Sometimes

Rarely or never

What do you typically eat or drink when you experience stress or negative emotions?

How do you feel about your portion sizes during meals?

I often eat more than I should

I sometimes eat more than I should

My portion sizes are reasonable

Which of the following describes your coping strategies when faced with difficulties following health advice?

I watch my favorite TV show or movie only after completing my daily workout or physical activity. I allow myself to indulge in a small portion of dessert after completing a balanced meal. I give myself permission to spend time on social media or other leisure activities only after completing a certain number of steps or physical activity during the day. None of the above. I just eat and do leisure whenever I want.

How do you think positive lifestyle changes could improve your life?

Reduce the frequency or severity of symptoms. Enhance my overall well-being and quality of life. Decrease my reliance on medications or treatments. Improve my ability to engage in daily activities. All of the above.

Do you smoke?

None at all

1 to 3 sticks per day

5 to 10 sticks per day

More than 10 sticks per day

How many hours of sleep do you typically get per night?

Less 4 hours

5-6 hours

7-8 hours

More than 8 hours

How do you feel about the quality of your sleep?

Poor

Fair

Good

Excellent

How do you describe your physical activity?

Sedentary (mostly resting with little or no activity) Light (mostly sitting/desk work or standing for long hours with occasional walking) Moderate (with exercise 2-3x a week or brisk walking or bicycling) Very Active (with exercise 5-7x a week or tasks requiring strenuous effort like long period of running, rapid movement, or bicycling uphill)

Have you ever been hospitalized or undergone any surgeries for the last 2 years?

Yes

Are you taking any of these medications or supplements?

Prescription medications Over-the-counter medications Herbal supplements or remedies Vitamins or other dietary supplements I'm not taking any medication or supplements

Do you recognize that there is a need for change in your current eating habits?

Yes, absolutely.

I'm not sure.

No, not really.

Have you actively sought information about improving your diet?

Yes, I have been researching.

I haven't started yet.

No, I haven't.

Do you believe that changing your eating habits will lead to positive outcomes?

Yes, I'm convinced it will.

I'm not sure about the outcomes.

No, I don't think it will make a difference.

Who do you currently live with?

I live alone

I live with family members

I live with roommates

I live in a community or shared housing

My living situation is complex

How often do you eat with others (eg, family, friends, etc.)

Never

Sometimes

Always

Meal preparation and food shopping:

I have supportive family or friends help with meal prep and shopping. I usually prepare the majority of my meals myself, and while it can be challenging at times, I'm committed to making healthier choices. Someone else prepares meals, but their choices may not align with my goals. I struggle to find support, making healthy eating a challenge. Meal preparation varies, and I'm open to exploring new ways to get support.

How supportive is your social network in terms of reaching your health goals?

Never

Sometimes

Always

Do you feel ready to take action to improve your diet in the next 30 days?

Yes, I'm ready

I'm not sure if I'm ready yet

No, I'm not ready

Have you talked to friends or family about changing your eating habits?

Yes, and they are supportive.

I haven't discussed it with them.

No, and I don't plan to.

How confident are you in your ability to make dietary changes?

Very confident

Somewhat confident

Not confident at all

How often do you weigh yourself?

Once a day

Once a week

Once a month

What are your reasons for wanting to lose weight?

Improve health Improve physical appearance Improve energy levels

Others please specify

How will achieving your goal make you feel?

On a scale of 1 to 10, how committed do you feel to reaching your goal?

Consider the reasons behind your desire to lose weight and the positive changes it will bring to your life.

Are you willing to invest time and effort in making dietary changes?

Yes, I'm committed to putting in the effort

I'm considering it but uncertain about the commitment

No, I don't think I can commit to it.

What will motivate you more?

Receive a sticker, a reward or compliment?

A constant reminder

A challenging and unfamiliar task

As you start on your weight loss journey, what's the most important change you're looking forward to?

Better relationship with food preparation

Finding Joy in what I do!

More self-love and self-care

Connecting with like-minded individuals

More confidence in my body

We predict that you will be

kg by 25 August

and lose 10 kg by the end of the program.

Weight Target kg

Achieve healthy BMI by 25 August.
Continue developing healthy habits to keep weight off after reaching goal
Feel comfortable and confident in your body.

Blood Sugar Control

Have you tried to make changes to your diet in the past year?

Yes, and I was successful

Yes, but I wasn't successful

No, I haven't tried

How important is it for you to improve your diet right now?

Extremely important

Somewhat important

Not important at the moment

Are there any specific barriers preventing you from making dietary changes?

Yes, and I'm actively trying to overcome them

I'm aware of potential barriers but haven't addressed them yet

No, there are no barriers

Analyzing your responses...

We predict that you will be

kg by 25 August

and lose 10 kg by the end of the program.

August 08, 2024 KG

Achieve healthy BMI by 25 August

Continue developing healthy habits to keep weight off after reaching goal

Feel comfortable and confident in your body.

Ready to start your Nutricoach program?

Yes, I'm ready to start NOW!

Next time, I'm not yet ready.

Hi! Welcome to Nutricoach!

Can you tell us your name?

Hi !

We are really excited to know you better!

Can you tell us more about you?

Hi !

Your well-being is our priority!

Hi !

Your well-being is our priority!

Currently, we're focusing on providing programs specifically for diabetes patients who are trying to lose weight.

However, stay tuned for upcoming programs that will cater to a wider range of health goals.

How do you like spending your free time? (Select all that apply)

What challenges do you face in maintaining diet and exercise consistency? (Select all that apply)

When was the last time you consulted with a Nutritionist-Dietitian?

How do you feel about having a nutritionist- dietitian guide you in managing your Nutrition?

How much will you be willing to pay for a one-month subscription on Nutricoach?

What's your height?

What's your weight?

Your BMI is approximately

Your ideal body weight based on your height is kg

Is this also your goal weight?

What's your goal weight?

Based on Mayo Clinic, the ideal recommended healthy weight loss is 0.5kg per week.

Are you diagnosed with hypertension?

What is your latest blood pressure reading?

Your blood pressure is approximately

What is your latest blood sugar reading?

Do you have any food allergies?

How often do you eat fast food or takeout?

How many servings of fruits and vegetables do you consume daily?

Do you consume any sugar-sweetened beverages (eg soda, juice, milk tea)?

How often do you think about making change to your diet?

Have you set specific goals for improving your diet?

How often do you plan your meals in advance?

Do you consume alcohol?

How often do you find yourself skipping meals?

Do you feel good when you skip meals?

Do you know about the possible health risks if adjustments to a diet are not considered for a person diagnosed with diabetes?

How many meals do you have per day (including snacks)?

How often do you use a food diary to track your food intake?

Are you under any stress or emotional distress?

How often do you eat due to stress or emotional reasons (eg boredom, anxiety, depression, work stress, etc.)?

What do you typically eat or drink when you experience stress or negative emotions?

How do you feel about your portion sizes during meals?

Which of the following describes your coping strategies when faced with difficulties following health advice?

How do you think positive lifestyle changes could improve your life?

Are you pregnant or breastfeeding?

Do you smoke?

How many hours of sleep do you typically get per night?

How do you feel about the quality of your sleep?

How do you describe your physical activity?

Have you ever been hospitalized or undergone any surgeries for the last 2 years?

Are you taking any of these medications or supplements?

Do you recognize that there is a need for change in your current eating habits?

Have you actively sought information about improving your diet?

Do you believe that changing your eating habits will lead to positive outcomes?

Who do you currently live with?

How often do you eat with others (eg, family, friends, etc.)

Meal preparation and food shopping:

How supportive is your social network in terms of reaching your health goals?

Do you feel ready to take action to improve your diet in the next 30 days?

Have you talked to friends or family about changing your eating habits?

How confident are you in your ability to make dietary changes?

How often do you weigh yourself?

What are your reasons for wanting to lose weight?

How will achieving your goal make you feel?

On a scale of 1 to 10, how committed do you feel to reaching your goal?

Are you willing to invest time and effort in making dietary changes?

What will motivate you more?

As you start on your weight loss journey, what's the most important change you're looking forward to?

Blood Sugar Control

Have you tried to make changes to your diet in the past year?

How important is it for you to improve your diet right now?

Are there any specific barriers preventing you from making dietary changes?

Analyzing your responses...

We predict that you will be

kg by 25 August

and lose 10 kg by the end of the program.

Achieve healthy BMI by 25 August

Continue developing healthy habits to keep weight off after reaching goal