Name
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First Name
Last Name
How old are you?
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Your email address
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Your phone number
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Your home postcode
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What type and level of support are you looking for?
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What is your budget for 1:1 nutrition coaching?
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Less than £550
£550-£1,000
£1,000-£4,000
£4,000-£5075
1) What do you most want to get out of working with me?
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Please tick ALL that apply.
Please note, these are the areas I CAN help with. If you're looking to address other concerns, it's unlikely I'm the right nutrition expert for you.
2) Which dietary approach are you interested in adopting?
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Please tick ALL that apply.
3) What kind of support do you need to achieve your goals?
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I need information and guidance to understand what to do (e.g. learn the basics through the Healthy Eating & Anti-Inflammatory Diet Masterclass)
I need practical, hands-on support to implement changes (e.g. meal planning, habit-building through the 360 Programme)
I need both information and practical support (e.g. masterclass plus add-ons from the 360 Programme)
4) Please tell me in 2-3 sentences what specific dietary/health concerns you’d like me to help you with.
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Aim for 30 words minimum.
5) What have you tried up until now to make progress towards your goals?
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6) And what, specifically, has stopped you from reaching your goals up until now?
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Aim for as much detail as possible. Tell me what you struggle with, e.g. lack of time, knowledge, cooking skills, motivation, support.
7) How strongly do you agree or disagree with the following statements?
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7a) Food plays a big part in my life.
7b) I really enjoy cooking.
7c) I rely heavily on convenience products to make cooking quick/simple (e.g. ready to cook, meal kits, prepared vegetables, etc).
7d) I enjoy trying new foods (e.g. from other cultures, chef creations, etc).
7e) I tend to go for premium rather than standard goods/services.
8) Where do you buy most of your food shopping?
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Please give supermarket and/or shop names, listing as many as you wish.
9) How often do you usually shop for food?
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Daily
4-6 times a week
2-3 times a week
Once a week
Once a fortnight or less
10) Where is the fresh fruit and veg you buy mainly grown?
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Scotland
UK (outside Scotland)
Abroad (outside the UK)
I’m not sure
11) On average, how often do you cook meals from scratch? (
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Every meal
Twice a day
Once a day
3-6 times a week
1-2 times a week
Less than once a week
Never
12) On average, how much time do you spend on food prep and cooking?
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1 hour or more a day
30-60 minutes a day
20-30 minutes a day
10-20 minutes a day
5-10 minutes a day
Less than 5 minutes a day
13) Do you ever cook as a way to relax, be mindful, or have fun?
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More than once a week
Once a week
Once or twice a month
Less than once a month
Never
15) Would your friends describe you as being in the 'live to eat' or 'eat to live' camp? (
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Live to eat
Neither
Eat to live
18) What are your biggest motivations for wanting to work with me in particular?
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Please tick ALL that apply.
19) If we're a good match, how would you like to pay? (
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Pay in full upfront
Pay in instalments
20) How did you hear about me?
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Search engine (e.g. Google)
Referral from a friend/family member/client
Another health/wellness professional
ME/CFS or chronic illness support group
Media (TV, radio, newspaper, magazine)
Social media (e.g. Instagram, Facebook)
Other
May I store your information securely to follow up about the programme?
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I’ll handle your data with care – see my Privacy Policy below for details. If you select ‘No’, I won’t be able to contact you.
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