This form is a tool to help both of us gain a clear understanding of what is currently working for you surrounding food/diet/nutrition, what your health goals are, and how I might be able to help and support you and your family.

 

Please be as detailed as possible and feel free to share anything you think is relevant. If any questions do not apply to you, feel free to leave it blank. This is simply our starting point and is meant to be as unique as you are. There are no wrong answers.

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Please print this form and fill it out.