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  • Nourish & Flourish Image

    Initial Assessment Questionnaire

    Getting To Know You (confidential)
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  • About You

    The more I learn about your lifestyle, your needs, etc. the more I can assist you.

  • What do you want to achieve?





  • How Ready, Able & Willing Are You?

    Be honest - no judgement here.
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  • Disclaimer

  • Please recognize that it is your responsibility to work directly with your health care provider before, during, and after seeking nutrition and / or fitness consultation.


    Any information provided is not to be followed without prior approval of your doctor. If you choose to use this information without such approval, you agree to accept full responsibility for your decision.

  • Whew! That was long but you made it!

    I will look over your form and get back to you within 48 hours. I can't wait to start working with you!
  • Susan
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