Client intake questionaire

To Download the form click below:

client assessment questionnaire

The purpose of the questionnaire is to gather information, and bring your attention to many details of your health. What you consume, how it moves through your body, how you process foods, the environment around you, exercise, and your sleep patterns are all vital to your health.

A week prior to our first meeting please keep a log of all foods and drinks you consume, times you eat, and the location you are while you are eating. Also please take note of your sleep times, and exercise routine. This will help tremendously in the evaluation process.

Thank you for your willingness to share this information, and take part in this journey that will improve your life. We are looking forward to working with you to make lifestyle changes to meet you specific needs.

We encourage you to visit your doctor for a physical prior to making the changes we are suggesting. Please feel free to share my suggestions with your physician, and get his/her opinion on them.

If there is any additional information you would like us to know, or your doctor has any specific recommendations please advise us.


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