Your Fit Fork Nutrition and Fitness Survey
Thank you for requesting a personalized nutrition and fitness package! As a dietitian, I believe one size does not fit all! Answer the following questions and I will email you back with a package that will be best for you and your goals.
Email address *
I offer a free consultation call to discuss program options and how I can best assist you. What is a good phone number to reach you at? *
Your answer
Name *
Your answer
What is your reason for wanting nutrition and/or fitness help? *
Your answer
Current Weight *
Your answer
Height *
Your answer
Do you want your package to include at home workouts streamed by video? *
My programs range from 4 weeks to 12 weeks. What is your budget for a health and wellness program? *
How often would you like to check in with your dietitian? *
Would you prefer to be part of a Facebook accountability group or just work in private? *
Do you currently exercise? *
Do you prefer exercise in private, at home, or in a gym with people? *
Do you want your nutrition package to include meals and shopping lists planned out for you? *
What diets have you tried in the past and what was your experience? *
Your answer
What medical concerns do you have? List pertinent diagnosis. *
Your answer
Please list medications you are currently taking. *
Your answer
How often do you eat meals at fast food or restaurants? *
How would you rate your level of commitment? *
Just curious
Completely dedicated and ready to feel better
What would you rate your level of fitness? *
Beginner
Advanced
A copy of your responses will be emailed to the address you provided.
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