Full Month


Your Name (required)

Your Email (required)

Your Phone Number (required)

What are your favorite foods?

What foods do you dislike?

What do you have as a treat?

What do you typically have for breakfast?

What do you typically have for lunch?

Do you have any allergies?

Are you willing to prepare breakfast or does it need to be quick?

Are you willing to prepare lunch or does it need to be quick?

Are you willing to eat raw veggies for snack (carrots, celery, sugar snap peas, green peppers, etc.)?

Do you like the following foods: almond butter, hummus, cottage cheese, cheese sticks, plain Greek yogurt, edamame, avocado, popcorn, raisins
(if you have not tried something on this list, let me know if you are willing to try it)?

Do you like the following proteins: Seafood (all types?), pork tenderloin, ham, turkey, chicken, ground beef, steak, veal, lamb?

Do you like to have vegetarian meals? If so, how often?

What are your favorite fruits?

Any fruits you do not like?

What are your favorite vegetables?

What vegetables do you not like?

What are your favorite snacks?

In your current schedule, how many times a day do you eat (i.e. Breakfast, morning snack, lunch, dinner, bedtime snack)

What is your current workout schedule?

What time of day do you workout?

Do you eat before you workout?

What is your daily schedule? (Wake up/bedtime, work schedule, etc.)?

How many people eat dinner with you (spouse, number of kids, etc.)?

What is your current weight and height, and what is your target weight?

What else do you think I should know about you that would help me be the most successful nutritional coach possible?

Preferred method of contact

Phone CallEmailText Message

Invoice me for this service