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Sports and wellness · Form

Sample پرسشنامه‌ی تغذیه

عادت‌های غذایی، رژیم‌های قبلی، حساسیت‌ها و اهداف برای مشاور تغذیه.

8 questions · Free up to 50 responses a month

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About this template

“پرسشنامه‌ی تغذیه” has 8 questions; 5 are required and 3 optional. Question types: Short text (1), Mobile number (1), Number (1), Decimal (1), Single choice (1), Dropdown (1), Multiple choice (1), Long text (1). 13 ready-made options across 3 choice questions, all editable in the online version.

In the online version of this template

  • Mobile numbers are validated against the Iranian number format.
Related:Online form builder

Questions in this template

  1. 1.

    نام و نام خانوادگی *

    (Short text)
  2. 2.

    شماره موبایل *

    (Mobile number)
  3. 3.

    سن *

    (Number)
  4. 4.

    وزن (کیلوگرم) *

    (Decimal)
  5. 5.

    هدف *

    (Single choice)
    • کاهش وزن
    • افزایش وزن
    • تثبیت
    • بهبود انرژی
  6. 6.

    چند وعده در روز؟

    (Dropdown)
    • ۱ تا ۲
    • ۳
    • ۴ تا ۵
    • بیشتر
  7. 7.

    پرهیز یا حساسیت

    (Multiple choice)
    • گلوتن
    • لاکتوز
    • گوشت
    • آجیل
    • هیچ
  8. 8.

    یک روز معمولی چه می‌خورید؟

    (Long text)

Printable or online?

Printable version (Word & PDF)

  • For filling in on paper, signing and filing by hand
  • Edit the Word file any way you like
  • Collecting and typing up the answers is up to you
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Online version on Porsino

  • Answers are collected and organised automatically — no retyping
  • National ID, mobile number and dates are validated instantly
  • Ready-made reports and charts, plus Excel export in one click
  • Share a link or QR code — it works on mobile too
Build the online version for free

How do I use this template?

  1. Sign up for Porsino for free; no bank card needed.
  2. In the panel, open “Templates” and choose “پرسشنامه‌ی تغذیه”.
  3. Change the questions as you like, publish the form and send the link.

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