Nutrition Coaching Application

What made you decide to work with a dietitian? *

What are your main nutrition goals? *

What are some obstacles holding you back from achieving your goals? *

On a scale of 1-10, how important are these goals to you? *

What do you want/need from a nutrition coach to be successful in reaching your goals? *

I ask my clients to track 3 days worth of their intake for me. This will help me learn about their dietary intake and how I can best help them lose weight. Are you willing and able to do this? *

My clients all use the “MyFitnessPal” or “Lose It!” app. These apps help keep track of your daily intake and exercise. It also shows you important information like how many calories you have had. Are you willing and able to do this? *

If this program is a good fit, are you able to financially invest in a nutrition program? *

Nutrition coaching is both a time and financial commitment. Is there anyone else that needs to be involved in the financial decision making (significant other, parent, etc.)? *

If at the end of our call, you feel that I've offered you a compelling roadmap towards building a truly realistic and successful nutrition plan that will help you reach your goals, do I have your commitment that you will make a decision about enrolling during our call. *

Full Name *

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Phone Number *

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