Nutrition Form

Nutrition Optimization

At MedTech Practice Management, nutrition is not an afterthought — it is the foundation that makes everything else work better.

Whether your goal is fat loss, muscle gain, hormone optimization, improved energy, improved digestion, or better recovery, your results will always be limited without the right nutritional strategy.

Labs and treatments tell us what’s happening internally.
Nutrition is what allows us to influence those pathways in a powerful, measurable way.

If you’re investing in hormones, peptides, thyroid therapy, GLP-1 medications, or structured training — but not dialing in nutrition — you are leaving results on the table.

First Name

Last Name

Phone *

Email *

Date of birth

Height

Weight

Estimated body fat % (if known)

Waist measurement (optional but helpful)

Medical & Hormone Background

Do you have any diagnosed medical conditions?

Are you currently on any of the following? (Check all that apply)

List all medications and supplements you currently take

For women: Are you cycling regularly?

Yes

If yes, average cycle length

Are you perimenopausal or postmenopausal?

Yes

How is your appetite?

Low

Moderate

High

Uncontrolled at times

Do you wake up hungry?

Yes

Current Nutrition Habits

How many meals per day do you currently eat?

Do you skip breakfast?

What time do you wake up?

What time is your first meal?

What time is your last meal?

Do you snack between meals?

How much water do you drink daily?

Do you track calories or macros currently?

Yes

If yes, what are your current macros/calories?

What does a typical full day of eating look like? (Be specific)

Training & Activity

How many days per week do you train?

What time of day do you train?

Do you currently eat before training?

Goals & Timeline

Is there a specific deadline or event?

What has NOT worked for you in the past?

Lifestyle & Compliance

How many days per week can you realistically cook?

Are you willing to eat 4–6 meals per day if recommended?

Yes

How consistent would you rate yourself (1–10)?

Body Composition & Recovery

Average hours per night

Stress level (1–10)

Do you struggle more with

Belly fat

Lower body fat

Upper body fat

Generalized weight gain

Do you feel you recover well from workouts?

Supplement & Peptide Support (Optional)

Yes

Already using them