Name
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First Name
Last Name
Email
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Phone
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What are your primary health and fitness-related goals?
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As best as you can remember right now, describe an average day of eating and drinking for you. If weekends vs. weekdays tend to be different, describe each.
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Right now, are you following any particular diet or style of eating? Are you avoiding any particular foods or food groups?
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If you are following a particular style of eating, how long have you been following this pattern of eating for?
What are some foods or meals that you enjoy the MOST
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What are some foods and meals that you DO NOT like?
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On a scale of 1-10, how consistent would you say your eating habits are? (1 being all over the place, and 10 being perfectly consistent all the time)
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Are there any parts of your routine (work, family, daily schedule, etc.) that you believe make following a consistent healthy eating pattern more challenging?
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Do you have any known or suspected food allergies or intolerances? If so, what are they?
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Do you have any digestive complaints right now? If yes, what are they?
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Do you feel like you have trouble controlling your appetite and/or hunger? If so, please describe.
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Do you experience food cravings? If yes or sometimes, what specifically do you normally crave?
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If you DO have cravings, what do you normally do?
Do you often experience brain fog and/or fatigue within 3 hours after a meal?
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How often do you normally prepare meals at home?
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How often do you normally eat meals in restaurants, cafeterias, or get take-out?
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Do you like cooking?
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Ideally, how much time would you spend cooking on a weekday?
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Do you like leftovers? If so, do you like all leftovers or only some types of foods?
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Thinking about all that you have written down here, what do you think you might like to start working on or addressing first? Do you have any specific questions or topics that you want to be sure to cover during our first session?
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