Introduction Assessment Form
This form is to give me a general idea of what you're looking for and what your current health situation is like so I can better assist you
Email address *
What are you looking to get out of this program?
Your answer
Do you have any food allergies? if so, what are they?
Your answer
How much of the food shopping do you do for your household? *
Do you mostly eat out or cook at home?
Your answer
What are some of your favorite foods?
Your answer
Do you have asthma or any other health conditions?
Your answer
Do you have any physical injuries or chronic pain?
Your answer
Do you have any dietary restrictions?
Your answer
Are you currently on a specific diet or exercise program? Please explain:
Your answer
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