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Holistic Diet Consultation Questionnaire
The purpose of this questionnaire is to help us understand your dreams, desires, & challenges around food, so we may use our consult time effectively & offer recommendations & recipes tailored specifically to your needs & desires.

There are many big questions below. A few of them (with the red asterisks) a required, but most are optional - of these, please only answer the questions that feel most relevant to you & your needs.

After receiving your form, we will get in touch to schedule your consultation. The cost of your first consultation (which includes typed recommendations & recipes sent to you after we speak) is $33-99, sliding scale, with a NOTAFLOF (No One Turned Away For Lack of Funds) promise.

We can also explore together options for more in-depth support - for example, we can make you a customized diet guide with menu plans, recipes, shopping lists, and more. To see what this can look like, check out our free FODMAP adventure guide at bit.ly/FODMAPguide, which we made for two friends who were going on a very restrictive elimination diet (psst .. it's full of delicious recipes!).

Thank you for saying YES to the adventure. <3

ABOUT YOU!
What is your name? How would you prefer to be called? *
Your answer
Your email (or other preferred contact information): *
Your answer
Do you have any known dietary needs or restrictions? *
Your answer
DREAMS & DESIRES
What does your fullest, most vibrant relationship with food & health look like? How would your life be different if this became a reality? *
Your answer
What do you most want to be eating?
Your answer
What do you see as your body’s ideal diet?
Your answer
CHALLENGES
What are your top three food or diet challenges? *
Your answer
What or how much does your present diet cost you (in money, emotional labor, integrity, etc.)?
Your answer
YOUR FOOD FLOWS
What is your diet like now? What's a typical food day or week like for you?
Your answer
How much time are you investing in food preparation/procurement? How does that feel?
Your answer
How is your shopping/food acquisition game? Challenges? Blessings?
Your answer
Does food happen collectively at Home? Do you shop, cook, or eat with others?
Your answer
MAKING CHANGE
How are you currently addressing the challenge of changing your diet?
Your answer
Have you been through something like this before? If so, how did you handle it then? How did that feel?
Your answer
What kind of support would you need, do you think, to make the necessary changes?
Your answer
How do you feel about changing your diet?
Your answer
Is there available time in your life right now, in which to invest in your diet? When can shopping & food preparation happen in your week?
Your answer
Are there presently opportunities to have fun with food & diet in your life?
Your answer
THIS CONSULTATION
What do you want most out of this food consultation? *
Your answer
When are you typically free to speak (for a 30 to 60 minute consultation)?
Mornings
Afternoons
Evenings
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Note here any specific time availabilities that would need be met.
Your answer
Over what medium(s) would you like to consult with us? *
Required
What ought we have asked that we didn't ask?
Your answer
Is there anyone else in your life that needs diet support? We invite you to forward them this form. Thank you. <3 .
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