Pre-Session Form — Fey Nutrition

Your name *

Age

Gender

City / State

What's your main goal? *

⚖️ Weight loss 💪 Healthy weight gain 🩺 Diabetes / pre-diabetes ❤️ Cholesterol / blood pressure 🤰 Pregnancy / postnatal 🏃 Sports performance 🫀 Gut / digestive health 🥦 General healthy eating

Anything specific? (optional)

Any diagnosed conditions? (tick all that apply)

Diabetes / pre-diabetes High cholesterol High blood pressure Kidney disease Thyroid condition PCOS Pregnant / breastfeeding None

Current medications or supplements (optional)

Food allergies or foods you avoid (optional)

What does a typical day of eating look like? (optional)

Activity level

🪑 Mostly sitting 🚶 Lightly active 🏃 Exercise 2–3×/week 🏋️ Very active

Preferred language

English Bahasa Malaysia

Preferred video platform

WhatsApp Video Zoom Google Meet

Which option are you interested in?

Single session 4-session package Monthly coaching Not sure yet

When do you prefer to have your session? (tick all that apply)

Weekday daytime Weekday evening Weekend

Anything else Fey should know? (optional)

Tell Fey a little about yourself