Rethink Food ~ Rethink Health
This short survey allow me to get a snapshot of your needs and desires for nutrition counseling services. Upon completion of the survey you'll be able to schedule a complimentary Strategy Session with me, a Functional Nutrition Counselor to discuss how I can best help you.

Are you ready for a fully support health transformation? It starts here!!
Email *
What is your name (first and last please) *
What email address may I use to contact you? *
I would love to know where you are located? (city and state) *
Are you filling this survey out for yourself or on behalf of another person? *
I would love to know how you found me, where you referred? *
What is your main goals for seeking nutrition counseling with me? *
Do you have any known health or medical conditions or diagnosis that I should know about in helping you find the best care? If yes, please explain.
What have you tried so far to address your goal? (diets, testing, modalities, etc.) *
Which of the following items are currently in your diet in any amount? (select all that apply) *
Required
What percentage of your meals are currently cooked at home? *
Please let me know anything else about you, your goals, for nutrition counseling with Rethink Food ~ Rethink Health or your health aspirations. *
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