PPMNY Mentee Intake Questionnaire
Thank you for your interest in the Plant-Powered Lifestyle Mentorship program with Plant Powered Metro New York! Please answer the following questions so we can make the best-fit match to support your transition to a whole food, plant-based (WFPB) lifestyle. Note that, in most cases, our volunteer mentors are not licensed medical providers but instead average people who have made a commitment to evidence-based healthy eating. Under no circumstance should individuals receiving mentorship forgo standard medical care, especially if you have a diagnosed illness. Anyone currently on medication is required to simultaneously work with their medical provider(s) throughout the dietary change process to adjust medications accordingly. Section 2 of this form includes a waiver to this effect that must be completed before getting started with a mentor. The focus of this mentorship program is elements of lifestyle, so you should continue to direct your medical and nutritional questions to licensed practitioners.
Name *
Your answer
Email *
Your answer
Why are you interested in adopting a whole-food, plant-based diet? *
Your answer
What are your personal barriers to adopting a whole-food, plant-based diet (check all that apply!) *
Required
Which option best describes how you currently eat? *
How long would you like your transition to be? *
How comfortable are you with cooking? *
Do you share a kitchen with others? (Check all that apply) *
Required
What is your zip code? *
Your answer
Which parts of the NY Metro area are easy access for you/which areas do you travel to frequently? (Check all that apply!) *
Required
How would you prefer to communicate with your mentor? (Please check all that apply!) *
Required
What times of the week are best for you to interact with your mentor? *
How frequently would you like to interact with your mentor? *
I would prefer to work with a mentor who is proficient in a language other than English (if so, please specify what language.)
Your answer
What are you looking to gain from the Lifestyle Mentorship program? *
Your answer
PPMNY requests a 3-month commitment for the Lifestyle Mentorship program. Can you make this commitment? Do you have any time constraints or travel plans that could interfere with regular interaction with your assigned mentor? *
Your answer
Depending on availability and cost, would you be interested in future intensive jumpstart programs offered by PPMNY? Jumpstarts offer support for a complete dietary transition in a short period of time, usually between 10-30 days, and one-on-one mentorship is provided. *
Is there anything else you would like us to know?
Your answer
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