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
What are you looking to get out of this program?
Do you have any food allergies? if so, what are they?
How much of the food shopping do you do for your household?
All of it
Some of it
None of it
Do you mostly eat out or cook at home?
What are some of your favorite foods?
Do you have asthma or any other health conditions?
Do you have any physical injuries or chronic pain?
Do you have any dietary restrictions?
Are you currently on a specific diet or exercise program? Please explain:
Send me a copy of my responses.
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