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Helene Patounas Nutrition - Health and Performance Questionnaire

Your personal and health information is collected only to create your tailored nutrition plan.

All information is stored securely on our GDPR-compliant servers, encrypted, and accessible only to our team members who need it. You have full control over your data, including the right to access, update, or request deletion. We will never share your data without your consent.

This questionnaire takes about 10–15 minutes to complete. It gives us the insight we need to design a precise, personalised nutrition plan for you.

Section 1 of 6: Your Goals

We ask about your goals so we can design a nutrition plan that’s aligned with what matters most to you, while helping you maximise your health and performance.

Q1. What are your health and performance goals? (Select as many as you like)

Q2. What are your top 3 priority health and performance goals? (Choose 3 only)

Q3. Are you currently training for a specific athletic event(s)?

Q4. If yes, which event(s) are you preparing for? (select all that apply)

Section 2 of 6: Your Symptoms

We ask about your symptoms to understand how you’re feeling day-to-day and to tailor support to your specific needs.

Q5. What symptoms do you have around Energy & Sleep? (Select all that apply)

Q6. What symptoms do you have around Mood & Cognition? (Select all that apply)

Q7. What symptoms do you have around Gut Health? (Select all that apply)

Q8. What Hormonal & Metabolic symptoms/conditions apply to you? (Select all that apply)

Q9. What symptoms do you have around Recovery, Inflammation & Pain? (Select all that apply)

Q10. What symptoms do you have around Immunity & Skin? (Select all that apply)

Q11. What symptoms do you have around Detoxification and Elimination? (Select all that apply)

Section 3 of 6: Lifestyle

Q12. How many days per week do you exercise for at least 45 minutes?

Q13. What % of your exercise sessions are 'hard' or 'high intensity'?

Q14. How many hours do you typically sleep per night?

Q15. How well do you sleep?

Q16. Do you smoke or vape?

Q17. How many alcoholic drinks do you typically have per week? (1 drink = 175 ml wine, or 330 ml beer, or 25 ml spirits)

Q18. Occupation / job activity level

Q19. Do you regularly work night shifts or rotating shifts?

Q20. How would you rate your current stress levels or life demands?

Section 4 of 6: Medical History

We ask about your current medications, supplements, medical conditions, and allergies so we can ensure your plan is safe, avoid harmful dosages or double-dosing, and prevent any potential interactions.

Q21. Do you have any diagnosed medical conditions?

Q21b. If yes, please list your diagnosed medical conditions and any relevant details.

Q22. Do you take any prescription or over-the-counter medications regularly?

Q22b. If yes, please list each medication with name, dose (mg), frequency, and reason if known?

Q23. Do you currently take any vitamins, minerals, herbs, or other supplements?

Q23b. If yes, please list any supplements you are currently taking

Q24. Do you have any known allergies or intolerances?

Q24b. Please give details of any allergies or intolerances (substances and reactions).

Q25. Have you had any recent nutrition related blood tests which show out of range markers? If so, please share here:

Q26. Would you be interested in relevant blood testing in the future to help further tailor your supplement protocol?

Section 5 of 6: Eating Patterns

We ask about your dietary patterns so we can understand your nutrition habits and create a plan that fills the right gaps

Q27. Do you follow any particular dietary pattern? (Select all that apply)

Q28. On average, how much meat or poultry do you eat every day? (1 palm of your hand = 25g)

Q29. How often do you eat oily fish?

Q30. How many servings of vegetables do you usually eat per day? (1 fist = 1 serving)

Q31. How many servings of fruit do you usually eat per day? (1 fist = 1 serving)

Q32. What are your favourite foods?

Q33. Which foods do you crave?

Q34. Which foods do you dislike?

Q35a. What % of your meals are home cooked?

Q35b. What % of your meals are take-away / pre-prepared?

Q35c. What % of your meals are from restaurants?

Q36. How much water do you drink per day?

Q37. How many caffeinated drinks (e.g. tea, coffee) do you consume per day?

Q38. How many soft drinks (e.g. fizzy soda, energy drinks) do you consumer per day?

Section 6: Food diary

Please share 2-3 x examples of your meals across a typical day, and state the approximate time you consume them. Please share as much detail and examples as possible.

Q39a. On rising

Q39b. Breakfast

Q39c. Mid-morning

Q39d. Lunch

Q39e. Mid-afternoon

Q39f. Dinner

Q39g. Evening Snacks

Section 7: Final Wrap-up & Consent

Q40. Is there anything else about your health, lifestyle, or goals that you’d like us to know?

Q41. Are you currently under the care of a doctor or nutrition professional for any of the issues you’ve mentioned?

Q42. Do you consent to us securely processing your data to create your personalised plan?