Please fill out the following form.
Preferred Method of Communication?*
Do you have any current medical conditions (Check any that apply)*
Are you currently taking any medications? *
Do you have any dietary restrictions or allergies?
Have you experienced significant weight fluctuations in past*
Do you have a family history of weight-related health issues or conditions?*
Are you pregnant or trying to become pregnant?*
Do you follow specific dietary plans?*
How often do you consume sugar?*
How often do you consume processed foods?
How often do you consume fast foods?*
How often do you consume alcohol?*
How often do you consume sweets/deserts?*
How often do you consume gluten?*
Do you feel like your eating habits are healthy*
Do you exercise regularly*
If "YES" to the question above, what types of physical activity do you engage in?*
Do you have any physical limitations or injuries that affect your ability to exercise
How would you describe your stress levels?*
Do you smoke or use tobacco products?*
How often do you consume alcohol?*
What are your primary goals for seeking nutrition and weight loss guidance?*
Have you tried to lose weight before?*
DO you experience emotional or stress related eating?*
Do you feel shame or guilt after eating?*
Do you track your food intake?*
How confident do you feel in your ability to stick to a nutrition plan long term?*
How confident do you feel in your ability to stick to a nutrition plan long term?*
Are you currently working with any other health professionals (e.g., personal trainer, therapist)?*