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Client Intake Form
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Email
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In order for me to provide you optimal service as a food health coach, please complete this form to the best of your ability.
How did you hear about Food Brilliance?
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Were you referred? Did you find us on Google? Let us know.
Your current situation
1. What is the main reason you are seeking a food health coach?
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(e.g. – a current health concern, the desire to learn more about maintaining a healthy lifestyle, or even the desire to learn more about cooking healthy food)
2. What are your health concerns?
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3. Do you have a health goal? If so, what is it? If not, would you be willing to create one?
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4. Do you have any dietary restrictions? List and explain.
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5. WHAT FOODS DO YOU EAT NOW? PLEASE PROVIDE A SAMPLE OF FOODS YOU EAT DURING A 3-DAY PERIOD.
Breakfast
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Lunch
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Dinner
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6. What foods work well for you? What foods do you have a hard time digesting?
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Getting to know you more
1. What foods did you grow up eating?
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2. How is your appetite? In the morning? After lunch? In general?
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3. Do you get food cravings? If so, what are your cravings? When do you usually have food cravings?
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4. What foods do you like? What foods don’t you like?
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5. Do any members of your family have food allergies or dietary restrictions?
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Bonus Questions. These questions will allow me to achieve a more holistic understanding about you and your life.
1. Are you willing to try new foods?
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2. Would you consider yourself an adventurous eater?
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4. How much water do you drink a day?
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5. Do you often feel fatigue? If so, what time of the day does this feeling occur?
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6. Do you feel satisfied after you’ve eaten?
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7. Do you snack between meals? If so, what do you snack on?
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8. Are you interested in learning about healing teas?
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9. Is there anything else you would like me to know about you?
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Home
Upcoming Events
Personal Cooking Instructor
About Ryann
My Training
Food for Thought
Contact