Uplift Studios Nutrition Coaching Questionnaire

This survey is designed to gather information relevant to making a health and wellness assessment in order to enable you to get specific, tangible, and sustainable results.

I am not a physician or registered dietician, and do not diagnose or treat disease. My recommendations come from research-based generally accepted scientific findings as well as anecdotal work with past clients.

Please fill out to the best of your ability. Please note which fields are required, and which are optional depending on your goals and interests.

Please note that only questions marked as "Required" require your response. If there are questions that are not required that you prefer not to answer (or do not apply to your goals or concerns), please feel free to leave blank.

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    Contact Information

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    Goals and Concerns

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    Current Diet and Nutrition

    Rather than dieting, finding out which foods work to fuel + sustain your body in a long-term, enjoyable way is the key to reaching your health goals. If you are working out regularly, you will have different nutrition needs from someone who is not.
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