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Laurent
Le Bosse
FEEL - CHALLENGE - IMPROVE
First name
*
Last name
*
Email
*
General Information
Age
*
Under 18
18 - 25
26 - 40
41 - 60
60+
Gender
*
Female
Male
Phisical activity level
*
Sedentary
Lightly active
Moderately active
Very active
Athlete
Nutrition habits
What type of diet do you currently follow ?
*
No specific diet
Omnivorous
Vegetarian
Vegan
Flexitarian
Plant-based focused but not fully vegan
Other
Other type of diet, specified
How many meals do you usually eat per day ?
*
1
2
3
4 +
How often do you eat plant-based meals ? (vegetables, legumes, tofu, nuts, plant proteins)
*
Rarely
1 - 2 times per week
3 - 5 times per weeks
Daily
Fully plant-based
How often do you consume animal proteins ? (meat, fish, eggs, dairy)
*
Never
1 - 2 times per week
3 - 5 times per week
Daily
Food choises and preferences
Which plant-based protein sources do you currently eat ? Select all that apply)
*
Lentils
Chickpeas
Beans
Tofu / Tempeh
Edamame
Nuts & seeds
Plant-based protein powders
How many servings of fruit do you eat per day
*
0
1
2
3 or more
How many servings of vegetable do you eat per day
*
0
1
2
3 or more
How often do you drink sweetened beverages ? (soda, energy drinks, sweetened juices)
*
Never
Rarely
1 - 2 times per week
3 - 5 times per week
Daily
Hydratation
How much water do you drink per day ?
*
Less than 1 L
1 - 1,5 L
1,5 - 2 L
More than 2 L
Goals and limitations
What are your primary nutrition goals ? (Select all that apply)
*
Improve overall health
Lose weight
Gain weight / muscle
Increase energy
Improve digestion
Transition to plant-based diet
Reduce animal product consumption
Other
If other primary nutrition goals, specified
Do you have food intolerances or allergies ?
*
No
Yes
if you have food intolerances or allergies, specified
Do you have any digestive discomfort after eating ?
*
No
Sometimes
often
Knowledge & Interest
How would you rate your nutrition knowledge ?
*
Beginner
Intermediate
Advanced
Are you interested in learning more about plant-based nutrition ?
*
Yes
Maybe
No
What nutrition topics would you like to learn more about?
*
Balanced meal structure
Plant-based proteins
healthy snacks
Meal planning
Hydratation
Sports nutrition
Digestive health
Supplements (vitamins, ,inerals, plant-based omega-3, super food, ect)
Other
If other nutrition topics, specified
Lifestyle factors
How many hours of sleep do you get per night ?
*
Less than 5
5 - 6
7 - 8
More than 8
How would you rank your stress level ?
*
Low
Moderate
High
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