Discovery Form Are you ready to break free and move forward? Start by filling out this form to tell me more about yourself. Name * First Name Last Name Email * Phone Country (###) ### #### Current Body Weight Ideal Body Weight What are your health, lifestyle, and dietary goals? Do you want to see changes in your body weight or composition? Have you ever followed a diet? (describe your experience) What do you hope to achieve through working with a nutritionist? Do you Exercise regularly? Yes No Do you feel your current diet is health? Yes No Do you have any digestive issues? Yes No Do you have a bowel movement daily? Yes No Rate your daily energy level on a scale from 1 to 10 1 2 3 4 5 6 7 8 9 10 How many times do you eat a day? Describe your typical breakfast, lunch and dinner? What time do you eat breakfast, lunch and dinner? Describe your typical snacks and what time you eat them. How many meals do you typically eat out weekly? 1 2 3 4 more than 4 Are there any foods you will not eat due to sensitivities, allergies or other reasons? How much time would you ideally want to spend in the kitchen per day? Do you like to food prep? Yes No Will you eat leftovers? Yes No Thank you!
