Please fill out this form for every followup minimum 24 hours before your scheduled appointment.

Please download a food diary here to keep track of what you are eating for 1 week before your appointments and bring with you to the appointment.

Name *
How consistent are you with the program?
How consistent are you with the program?
I don't follow my nutrition guide
I eat all my meals on time within 1 hr of program
I never eat anything on the avoid list
I eat breakfast, lunch, snack and dinner every day
I eat breakfast within 1 hour of waking
I take my supplements consistently every day
I have 1-2 regular bowel movements every day
I go to bed no later than 10 PM on weeknights
I sleep minimum 7-8 hours most nights
I find it easy to go to sleep
I binge weekly or more
I have uncontrollable cravings
I have stable energy and no drastic blood sugar swings throughout the day
I am passionate about my life
I feel the future looks bright for me
I am benefitting from the nutrition program
I am not taking any addictive substances like tobacco, drugs or marijuana
I drink more than 2 coffees daily
I drink more than 10 glasses of wine or beer per week
I start every morning with 1 large glass of hot water with lemon
Note down day, time, amount and what you ate or drank, please.