Apply to work on your nutrition with me
Please fill out as honestly and throughly as possible. All this is relevant information that I can use to help you in the future.

Once you submit the form, I will have a look over the answers and give you a quick call for a chat and to arrange a face to face consultation if appropriate.

Thanks Cara.
Sign in to Google to save your progress. Learn more
Email *
Full Name *
Contact number *
What are the outcomes that you want to achieve? *
How long have you wanted to make a change to your lifestyle or the way you feel and look about yourself? *
How do you feel about yourself at the moment? *
Why have you reached out and contacted me at this time? Has anything changed for you recently? *
Have you ever set your own goals before and if so what where they? *
Do you have a goal in mind which you would like to achieve? That could be a body goal, health or wellbeing. Are you doing at the moment to move towards that goal? *
Estimate on a scale of 1-10 (1 is low and 10 is high) how ready you are to prioritise changing your eating habits.1 is “not ready”and 10 is “definitely ready”. *
Not Ready
Definitely Ready
How would you describe your relationship with food? *
Have you tried any diets in the past. If so were they successful or unsuccessful? And what aspects of them did you find worked or didn't work well for you? *
How would you describe your current diet? *
Are there any factors in your life which you feel could become an issue and you would have to overcome to consistently work towards achieving your goals? *
How do you want to feel around food? *
How do those around you feel about food? Are there any objections from those closet to you around changing what and when you eat? *
How long do you anticipate it will take you to reach your goal? *
Are there any big events coming up in the next 6-9 months for you? *
Have you ever had an eating disorder or currently think you may do? *
What do you feel that you will gain by working with a coach such as myself? *
Thank you for filling out this form, next step is to book in a Zoom call with me to discuss further. Please use the link below to do so. Thanks *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Classes with Cara. Report Abuse