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Do you have any pressing health concerns or health goals?

Why are you considering hiring a nutrition coach? 

How is that present health concern affecting your life?

What are your goals?

What is your diet and or nutrition history?

What is your health history?

Do you cook?
What are your favorite foods? 

What are your least favorite foods? Any allergies?

Current Activity Level: High? Medium? Low?
What do you do for exercise?
How many times a week?
What do you do for work?
What are the main challenges or limitations that you experience in your daily life that keep you from reaching your goal?
If you could remove any thoughts, challenges or limitations that you feel stop you from reaching your goals, what would they be? 

On a scale of 1 to 10 how committed are you to learning and making the changes you need to reach your goal? 

What are your expectations from me? How best can I help you? 

Success is earned - Self-belief and hard work required. So much of what it takes to make this journey successful is finding what drives us and what trips us up. We will discover that together on this path to better health. With that in mind please reflect and answer the following questions:

The Nitty Gritty

Thank you for taking the time to thoroughly fill this out. I’ll process this and get back to you with your Introduction Guide and Macro prescription.

Office Hours: Mon-Fri 9AM-5PM
507.210.9430 | amie@summithealth.fitness

Thank you! Your in-take form has been received successfully. We absolutely can not wait to get to know you better. We will be in touch as soon as possible.

In-Take Form

I know we covered a lot of this in person but please provide me as much as you can here. This will serve as a great reference for us in the future so the more specific you can be the better.