Mark which areas of wellness you want to work on:
Improve eating habits
Improve physical activity
What area of wellness do you want to improve the most?
What foods do you eat on a normal basis for:
List your favorite foods:
List foods you dislike:
Do you cook
What percentage of your food is home-cooked?
Where does the rest come from?
Do you experience cravings? If so, what?
Describe any food allergies or prohibitions:
The most important thing I can do to improve my nutrition is:
Describe your current level of physical activity:
List the physical activities you enjoy:
List the physical activities you enjoyed as a child or young adult:
What gets in the way of being physically active?
Wha strategies can you implement to overcome those obstacles?
Time of day when your energy is the highest:
Time of day when your energy is the lowest:
What things boost your energy?
What things drain your energy?
How do you feel when you wake up in the morning?
How do you feel when you go to sleep at night?
What is your night time/bedtime routine?
Describe your general stress level:
How does stress impact your health?
Describe the things that cause you the greatest stress:
Describe the measures to reduce stress in your life that you have tried over the past ten years, and the results and lessons learned:
Describe the activities that give you the most enjoyment, satisfaction, or sense of well-being:
Weight and health:
Are you at your desired weight?
If no, how much would you like to lose or gain?
What do you suspect is causing your weight issue?
Please list and describe any weight management programs or diets you have tried:
Change your life through food.