nutrition questionnaire

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nutrition questionnaire

Will a Nutritionist help me?

   
Please use this nutrition questionnaire to see if one of our nutritionists could help you.

yes no
Do you have less energy than you used to?

yes no
Do you think you would benefit from losing weight?

yes no
Do you suffer from headaches

yes no
Does it sometimes feel like you are full of poison/rubbish?

yes no
Are you compulsively drawn to certain foods?

yes no
Do other people seem to recover from things more easily than you?

yes no
Would you like to understand how best to eat for your body type, ancestry type and mental outlook?

Finally to complete this nutrition questionnaire, on a scale of 1 to 5 where 1 is a little and 5 very much, how prepared are you to:

Make an investment in your long term health?

one two three four five

Change your eating habits even when it is difficult for you?

one two three four five

 

If you answer yes to 2 or more on the first questionnaire and have scored 6 or more in the second set of questions contact our coaching team at nutritionists@thebodymindandsoul.com to arrange a 20 minute free taster session on the phone.

Or fill in the form below and the answers from above will be sent along with your details.

Mr. Mrs. Ms.

Name

Email Address:

Telephone Number:

Other Comments:

 
   


 

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