Welcome to BuenoSeeds Nutrition This assessment is the first step in understanding your current health status, eating patterns, lifestyle habits, and personal goals. Please reserve about 15-20 minutes and opt for a laptop or desktop to be more comfortable while answering the questions.
At BuenoSeeds Nutrition, we focus on identifying and addressing the dietary and lifestyle factors that may be contributing to inflammation, low energy, digestive discomfort, weight challenges, and other health concerns. Our approach combines evidence-based nutrition, culinary expertise, and practical habit transformation to help clients create sustainable, long-term health improvements.
Please complete this assessment as thoroughly and accurately as possible. The information you provide will be reviewed prior to your consultation and will allow us to make the most effective use of our time together.
This evaluation is designed to help us understand:
• Your health history and current concerns
All information submitted through this form is confidential and will never be shared with third parties without your authorization.
Thank you for taking the time to complete this assessment. We look forward to supporting you in creating a healthier, more resilient, and energized version of yourself.
What brought you to BuenoSeeds Nutrition?
Have you tried doing a nutrition program before? If yes, tell a bit why it did not work for you.
Do you see yourself as an emotional eater? If yes, what are the emotions you feel that makes you want to eat?
Which of the following foods do you consume regularly? Select all that applies: * Required
Fried foods (1 or more times per week) Examples: French fries, fried onions, fried cauliflower, fried mushrooms, fried chicken, tempura, etc.
Dairy products (1 or more times per week) Examples: Milk, yogurt, cheese, butter, cream, cottage cheese.
Processed meats (1 or more times per week) Examples: Ham, turkey slices, roast beef, deli meats, smoked salmon, sausage, hot dogs, bacon.
Packaged or highly processed foods (1 or more times per week) Examples: Chips, crackers, packaged snacks, frozen meals, instant foods, packaged desserts, ready-to-eat products.
Red meat (1–3 or more times per week) Examples: Beef, steak, ground beef, lamb, bison.
Poultry (1–3 or more times per week) Examples: Chicken, turkey.
Pork (1–3 or more times per week) Examples: Pork chops, pulled pork, bacon, ham.
Fish or seafood (1–3 or more times per week)
Eggs (1–3 or more times per week)
Every day eat at least one portion of: * Required
When it comes to breads.... * Required
What about sweets? How often you have one sweet bite? * Required
Do you snack during the day? If yes, how many times? * Required
Please list the foods you usually snack. If you don't snack, write 'I don't snack'.
What are your favorite foods? List all you love
What are your favorite food style? Italian, American, Asian... It can be more than one
What are the foods that you cannot stand? List all, including spices, ingredients, flavors you dislike.
What time do you sleep and what time do you wake up?
What time is your last eating of the day?
Would you like to improve your hormones? * Required
If you know something about your hormonal situation, please share below:
Are you allergic to any foods/ ingredients? Do you think you are in your best body shape? Do you drink coffee everyday ? What do you want to take out of this program? * Required
Let' talk about your daily water intake * Required
The water I drink is from * Required
Morning Routine : Thinking about a typical day, please place the following activities in the order you usually perform them after waking up. Use numbers to indicate the sequence (1 = first activity, 2 = second activity, etc.).
Do you work out? If yes, how many times per week? What kind of work out? How long each session?
Do you go to the bathroom every day? If the answer is 'no', how many times per week do you go? How is the consistance?
Any other routine you want to share that was not listed? Please write below
Do you currently have any diagnosed medical conditions, ongoing symptoms, or health concerns? If yes, please provide details below: • Medical condition(s) or diagnosis • Current symptoms (if applicable) • Medications currently taking • Supplements currently taking • Any other treatments or therapies you are receiving
Do you know about any medical history in your family? If yes, please explain.
Are you taking any supplementation? If yes, please write their name and brand bellow.
Are you aware of heavy metals in your body an products such as toothpaste, deodorant and other daily essentials? Have you heard of Epigentics? Have you heard of NLP? (Nerolinguistic Programing) Do you know about fasting and it's benefits? Are you familiar with subconscious, unconscious and conscious mind? If so, please explain the difference. This will help me understand how we can work your eating habits towards sucess of you achiving the results you desire with anti-inflammator nutrition.
Acknowledgment You acknowledge that any nutritional recommendations provided through BuenoSeeds Nutrition are intended to complement—not replace—your medical care. You should not discontinue, modify, or avoid any prescribed medications, treatments, or medical recommendations without first consulting your healthcare provider.
Next Step: Secure Your Appointment
Once you complete this assessment, click “Submit” to proceed. You will be redirected to the scheduling and payment page, where you can select your appointment format (online or in person) and confirm your consultation by completing payment.
If your appointment has already been scheduled, you will be directed directly to the payment section.
Important Information The Initial Nutrition Assessment is a separate service and is not included in the cost of any nutrition protocol or program. This comprehensive evaluation allows us to review your health history, lifestyle, goals, and current challenges so that personalized recommendations can be developed and the most appropriate next steps determined for your individual needs.
Next Step: Secure Your Appointment We understand that unexpected situations may arise. If you need to cancel or reschedule your appointment, please notify us at least 48 hours in advance to receive a full refund.
Appointments canceled with less than 24 hours' notice will incur a $75 cancellation fee. Any remaining balance may be applied as a credit toward a future appointment.
To cancel or reschedule, please email:
contact@buenoseeds.com
