Intake form

Welcome! We are so excited you’ve made the decision to improve your wellbeing and quality of life through nutrition therapy. We find it very helpful to learn a little bit about you prior to our first session. This helps us to better understand your needs, preferences, and goals in order to offer realistic and personalized care for your health concerns. For any questions that are applicable, you can write “N/A”.

Please complete this intake form and also e-mail over a 3-day food log at least 24 hours before our appointment. If you have any questions, please reach out to me at

Thank you for completing this!