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Peak Nutrition Pro

Food Diary

Please fill out the form below to the best of your ability. The more detail you provide, such as portion sizes,  amounts and brand names, the more we can tailor our time together to meet your individual diet and nutritional needs and goals.

All responses are private and confidential. Please ensure you submit your questionnaire NO LATER than 3 days before your initial consultation.

*Please note this form cannot be saved, it is advisable to enter all the details from your 3 days of food diary at once*.

If you require any assistance completing the form below, please contact us on:

Please provide details below of all the food and drinks you consume over a 3-day period, include 1 weekend day. Please complete as accurately and honestly as possible and include portion sizes and brand names where possible;
Please double check the details you have provided above are accurate, all required fields are completed and you have read the 'Food Diary Terms & Conditions' at the bottom of this page. Please click the 'Submit' button below once you have completed all applicable sections. Thank you.

Food Diary - Terms & Conditions

The Diet & Nutrition Advisor requests that the client notes the following:

  • The degree of benefit obtainable from the recommendations may vary between clients with similar health problems and following a similar programme.
  • Diet & Nutritional advice will be tailored to support health conditions and/or health concerns identified on the food diary.
  • We are not permitted to diagnose, or claim to treat, medical conditions.
  • Diet & Nutritional advice is not a substitute for professional medical advice and/or treatment.

The client understands and agrees to the following:

  • You are responsible for contacting your GP about any health concerns.
  • If you are receiving treatment from your GP or any other medical provider you should tell him/her about any nutritional strategy provided by a Diet & Nutrition Advisor. This is necessary because of any possible reaction between medication and the nutritional programme.
  • It is important that you tell your Diet & Nutrition Advisor about any medical diagnosis, medication, herbal medicine or food supplements you are taking as this may affect the nutritional programme.
  • If you are unclear about the agreed programme / food supplement doses / time period, you should contact your Diet & Nutrition Advisor promptly for clarification.
  • You must contact your Diet & Nutrition Advisor should you wish to continue any specified supplement programme for longer than 3 months, to avoid any potential adverse reactions. In any case we recommend a regular review of supplements to ensure they remain appropriate for your needs.
  • You are advised to report any concerns about your programme promptly to your Diet & Nutrition Advisor for discussion / action.
  • Please note we do recommend that all supplements are taken at different times of the day to any prescribed medications.

We would always recommend you discuss any dietary or supplemental concerns or changes you wish to make with your General Practitioner. Medication should never be discontinued or dosage amended without your G.P.’s prior knowledge and agreement.

I understand the above and agree that the nutrition & health questionnaire service provided by Peak Nutrition Pro will be based on the content of this document. We declare that all the information we share on this food diary is confidential and, to the best of our knowledge, true and correct.