Request edit access
Assessment Survey

Why We Ask for an Assessment Before Your Discovery Session

Before we meet for your free discovery session, I ask you to complete a short assessment to better understand your unique health concerns, goals, and challenges. This allows me to make the most of our time together by tailoring the conversation to your needs, ensuring you feel supported and heard from the very start.

Your responses help me determine if we’re the right fit and how I can best support you. My goal is to provide personalized, trauma-informed guidance—and this first step helps set the foundation for a session that’s truly meaningful for you.

👉 Ready to get started? Complete your assessment today, and let’s chat!

Sign in to Google to save your progress. Learn more
Email *
Name *
Is this on behalf or yourself or another person?
How did you find me?
What are your main goals for seeking nutritional counseling?
Do you have any known health or medical conditions or diagnoses?
What have you tried so far to address your goal?
Clear selection
Which of the following items are currently in your diet?
What percentage of your meals are homecooked?
Clear selection
Have you participated in any form of nutritional counseling before?
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms