Nutrition Intake
Please be 100% open and honest so I can help you reach your goals with nutrition and fitness!  I am here as a GUIDE and cannot prescribe, however I can recommend ways to improve your overall relationship with food and create weekly plans as a tool for learning and taking steps to reach your goals.
Remember this is a learning process and cannot work itself out in just a week.  Creating a lifestyle and hitting goals takes time, effort, and communication together!!!    I want to be a teacher, supporter, and cheerleader.  I am in YOUR corner!  Please send payment to Kathryn Isaac at Venmo @KatieIsaac419 or Zelle 724-822-7288
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Name *
Email *
Phone Number *
Do you have any underlying health conditions I should know about? If so explain and include medication/vitamins/supplements if currently using. *
Tell me about your hormones (if applicable) cycle/perimenopause/menopause, etc. *
What is your current relationship with food? Details help including emotional eating, past diet habits, etc. *
What currents habit(s) do you have that you feel need to change or need help working through such as late night snacking, binging, impulsive eating, etc. *
What is  your biggest struggle when it comes to food? This could be fear of trying new foods, over or under eating, poor planning, picky, avoidance, etc. *
What dietary restrictions (if any) do you have? Do you know if any foods cause irritability (not necessarily allergy related). *
What are your favorite foods? *
What foods do you dislike/avoid? *
Please describe your goals and what outcomes you desire when working together? Please be as descriptive as possible. *
Have you worked with someone regarding your  nutrition in the past?  If yes, please tell me how that went. *
Please provide a 24 hour snapshot of what a typical day of eating looks like for you including anything you use to cook with, and liquids. *
How is your digestive system working regarding elimination?
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Do you have a budget for food?  If so what is it?  When do you grocery shop? *
What's your fitness activity on a weekly basis? *
What are your current sleep habits? *
What is your stress level on a scale of 1-10 with 1 being low and 10 being the highest? *
What is your current weight and your ideal weight?  Why is that so important to you? *
Do you own a digital food scale? (this isn't required) *
What kitchen gadgets (beyond stove and microwave) do you have in your home? *
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