Nutrition Coaching

Let’s see if we’re a good fit!

Name

First Name

Last Name

Phone

(###)

###

####

Subject

What are your current health goals?

weight loss, energy improvement, digestive health, better relationship with food,

What do you hope to achieve by working with a nutrition coach?

guidance on meal planning, understanding portion sizes, overcoming emotional eating,

Do you follow any specific diet or eating plan?

vegan, paleo, keto, intermittent fasting, etc.

Do you have any medical conditions or take any medications that could impact your nutrition?

diabetes, thyroid issues, allergies, digestive disorders, etc

Have you worked with a nutritionist or dietitian before? If so, what was your experience like?

How active are you on a weekly basis?

sedentary, light exercise, moderate exercise, heavy exercise

Do you have any food allergies or intolerances?

gluten, dairy, nuts, etc.

What do you feel are the biggest barriers to achieving your nutrition and wellness goals?

lack of time, stress, emotional eating, cravings, busy schedule, lack of healthy rhythms

Is there anything else you’d like to share that could help me understand your needs and goals better?