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.

At this time, due to the ongoing situation with Covid-19, PPMNY’s mentorship program will be conducted virtually, with no in-person interaction between mentors and mentees. However, there is no better time than now to initiate healthy, sustainable lifestyle change (the best match for Covid-19 is a healthy immune system!), and the support and encouragement that makes a mentor so valuable is just as powerful virtually. Mentoring pairs are strongly encouraged to attend PPMNY’s virtual events together, to further become part of a community with shared values around nutrition and health.
Name *
Email *
Phone number
Why are you interested in adopting a whole-food, plant-based diet? *
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? *
Where in the NY Metro area do you live? *
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.)
What are you looking to gain from the Lifestyle Mentorship program? *
PPMNY requests a 30-day commitment for the Lifestyle Mentorship program (though mentees and mentors have the option to extend the mentorship up to 3 months if they mutually agree). Can you make this commitment? Do you have any time constraints or travel plans that could interfere with regular interaction with your assigned mentor? *
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?
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