1. Personal Information

    2. Weight History

    3. Health & Medical History

    Do you have or have you had (please tick all that apply)

    4. Hormones & Metabolism

    Are your menstrual cycles regular?

    Do you experience difficulty losing weight despite dieting?

    Are you peri-menopausal or menopausal?

    Do you feel cold, tired, or sluggish often?

    Do you experience sugar cravings?

    5. Lifestyle & Activity

    6. Eating Habits

    Do you skip meals?

    Do you snack between meals?

    Do you eat late at night?

    Do you eat when not physically hungry?

    7. Typical Day of Food

    What does a typical day of eating look like?

    How many litres of water do you drink per day?

    8. Cravings & Triggers

    9. Emotional & Behavioural Patterns

    10. Sleep & Stress

    11. Diet History

    Have you followed diets before? (e.g. keto, slimming clubs, fasting, etc)

    12. Environment & Practical Factors

    13. Goals & Expectations

    14. Commitment

    On a scale of 1–10, how ready are you to change?

    15. Anything Else