Work With Me
Work With Me
I'm so excited to be working with you. To get us started out, please fill out the form below. And, please, be as open and honest as you can. There are no judgements here.
Weight six months ago
Weight one year ago
Would you like your weight to be different? If so, by how much?
# of children
# of pets
Hours of work per week
Please list your main health concerns and your health goals
At what point in your life did you feel your best?
Any serious illnesses/hospitalizations/injuries?
How is/was the health of your mother?
How is/was the health of your father?
What's your blood type?
What is your ancestry?
How is your sleep?
How many hours do you average a night?
Do you have trouble falling asleep? If so, why?
Do you wake up at night? If so, why and for how long?
Are you usually tired throughout the day?
Any pain, stiffness, or swelling?
Look at your nails. Do you have any white spots on them?
What about constipation, diarrhea, or gas?
How frequently do you go No. 2?
Do you have any known allergies or sensitivities?
Do you take any medications or supplements? Please list if so.
Are you involved with any healers, helpers or therapies? Please list if so.
How's your libido?
Are you cold all the time?
Are your hands and feet often colder than the rest of your body?
Rate your stress level on a scale from 1 - 10 (10 being really stressed out).
What role does sports and exercise play in your life?
What did your food look like as a child? Please list examples of breakfasts, lunches, dinners, snacks, and beverages consumed when you were a child.
What does your food look like now? Please list examples of breakfasts, lunches, dinners, snacks, and beverages you consume now.
What are your go-to comfort/stress/period foods?
Do you drink alcohol? If so, how many drinks per week?
Will you family and/or friends be supportive of your desire to make food and/or lifestyle changes?
Do you cook? If so, what percentage of your meals are home-cooked?
Where do you get the rest of your food from?
Do you crave sugar, coffee, cigarettes, or have any other major cravings or addictions?
The most important thing I can change about my diet to improve my health is:
Anything else you'd like to share? Don't be shy. I want to know.
Thank you! So looking to diving in soon!