About You

Email

Address

Phone number

Height

Weight

Tell me about yourself

Lifestyle, occupation, illnesses, dietary needs - not your goals

Goals

Let me know what you want to achieve so I can help you reach your potential

Other

If you have any other goals, let me know what they are and how important they are to you (optional)

Expand on your goals

Quantify your targets, lay out your expectations, your timescale and tell me about your previous experiences

Your Current Diet

How many meals do you eat per day (on average)?

What kind of food do you eat?

Do you eat very similar meals each day? Are your eating patterns varied/erratic? Do you cook your meals?

Describe a typical day of food and drink for you

Breakfast

Snack

Lunch

Snack

Dinner

Snack

What is the goal of a typical day's eating for you?

If yes, please list the supplements/medications

Quantities, consumption, brands, etc.

List any medications or supplements (along with approximate dates) you have used in the last year

This includes antibiotics

Support

Tell me in simple, pratical terms, what you need to achieve your goals

What can I do to assist you? What can you do to help you attain your own goals?

Please indicate the budget most applicable to your current situation

Why? The services offered vary in terms of the level of support, time and client effort required. By knowing your budget, I can more effectively advise on the appropriate and effective service for your individual goals

Do you have any dietary requirements?

Any foods that you can't eat or dislike?

What does success look like to you in 3 months, 6 months and 12 months?

3 months

6 months

12 months