Holistic Diet Consultation Questionnaire
Greetings! Thank you for reaching out to support your life!

The purpose of this questionnaire is to help us understand your dreams, desires, & challenges around food, so we may use our consultation time effectively, and to be able to recommend recipes tailored specifically to your needs & desires.
If you prefer to answer these questions over the phone, please call us at 732.306.8400.

There are many big questions below, but only those with *red asterisks* need a response.
Please only answer the questions that feel most relevant to you & your desires.

After receiving your form, we will be in touch to schedule your consultation. The cost of your first consultation is $33-99, sliding scale, with a NOTAFLOF (No One Turned Away For Lack of Funds) promise. This yields our typed notes, recommendations, and recipes sent to you after we speak.

After our initial consultation, it would then be possible to explore further options for more in-depth support - for example, we can make you a customized diet guide with menu plans, recipes, shopping lists, and more. To see what this can look like, check out our free FODMAP adventure guide at bit.ly/FODMAPguide, which we made for two friends who were going on a very restrictive elimination diet (pssst .. it's full of delicious recipes!).

Thank you for saying YES to the adventure. <3
Are you seeking consultation for just yourself, or for your household?
ABOUT YOU or YOUR HOUSEHOLD!
By what name(s) do you prefer to be called? *
Your answer
Please share also any of your preferred pronouns. Thank you.
Your answer
What is your preferred email address (or other preferred contact information)? *
Your answer
Do you have any known dietary needs or restrictions? *
Your answer
DREAMS & DESIRES
What could your fullest, most vibrant relationship with food & health look like? How might your life be different if this became a reality? *
Your answer
What do you most want to be eating?
Your answer
What do you see as your body’s ideal diet?
Your answer
CHALLENGES
What are your top three food or diet challenges? *
Your answer
What or how much does your present diet cost you (in money, emotional labor, integrity, etc.)?
Your answer
YOUR FOOD FLOWS
What is your diet like now? What's a typical food-day or food-week like for you?
Your answer
How much time are you investing in food preparation & procurement? How does that feel?
Your answer
How is your shopping/food acquisition game? Challenges? Blessings?
Your answer
Does food happen collectively at Home? Do you shop, cook, and/or eat with others?
Your answer
MAKING CHANGE
How are you currently addressing the challenge of changing your diet?
Your answer
How do you feel about changing your diet?
Your answer
Have you accomplished large transformations before? If so, how did you do it? And how did it feel?
Your answer
What kind of support would you need, do you think, to make the necessary changes?
Your answer
Is there available time in your life right now, in which to invest in your diet? When can shopping & food preparation happen in your week?
Your answer
Are there presently opportunities to have fun with food & diet in your life?
Your answer
THIS CONSULTATION
What do you want most out of this food consultation? *
Your answer
When are you typically free to speak (for a 30 to 60 minute consultation)?
Mornings
Afternoons
Evenings
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Note here any specific time availabilities that would need be met.
Your answer
Over what medium(s) would you like to consult with us? *
Required
What ought we have asked that we didn't ask?
Your answer
Is there anyone else in your life that needs diet support? We invite you to forward them this form. Thank you. <3 .
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