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The Cultural Dietitian

Client check-in form

In order to reach full success and have the most accurate and effective consultation, please be very detailed when filling out your check-in form.

 

This is a self reflection tool - please reflect on your week and what you really need to get out of this follow-up consultation. Do not rush this process as we want our consultations to be highly conducive to your success. 

Please complete 24 hours before your call so that I can be the best and most effective RD for our services together. Thank you.

* Required

What's at least one WIN you've had in your health, well-being, or life in general, since we last spoke? Remember non-scale and habit-based wins are what we are going towards for long-term success!

* Required

How would you rate your energy levels?PoorFairGoodVery goodExcellent How would you rate your energy levels?
How would you rate your stress levels?PoorFairGoodVery goodExcellent How would you rate your stress levels?
How would you rate your sleep quality?PoorFairGoodVery goodExcellent How would you rate your sleep quality?