This form helps me understand your past and current health status.
Please be thorough!
Intake Form:
This form gives me a lengthy, but necessary picture of your current health, as well as your health history, please be thorough!
Health Objectives:
This form helps you define your goals to inform our work together.
Food Journal:
Please print three copies and give a detailed description of what you eat (3 days do not need to be consecutive). Please be very specific when inputting food choices. For example, if you have a burrito for lunch, please denote the specific ingredients and amounts as this will help me gather more accurate information. You will also be asked to include the beverages you consume, any medications or supplements you may take, your daily exercise and your bowel movements.
It is my hope that this food journal will be completed thoroughly and thoughtfully so that it provides the vital information needed to meet any possible nutrition challenges head-on. My intention is to evaluate your current nutrition, not to judge the choices that you are making. Please be completely honest in your documentation so that together we can set goals and move forward.
Personal Observations Form:
This is a questionnaire that will help you reflect on the feelings and energy levels that are created when you eat certain foods. Please use the questions on the top of the personal observations form as a guideline. You do not have to answer these daily, but rather you may want to make notes on the back of your food journal when you have ideas and take time at the end of the week to synthesize those notes into a synopsis of your overall feelings and any things you may have learned through the experience of doing the food journal. This will help guide you as you progress and begin to make nutritional changes.
Disclaimer Document:
Please feel free to contact me with any questions at all. I hope you enjoy this first step in the process of achieving profound wellness.
