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Welcome. Let's begin with clarity.


Your story matters. This short survey helps me understand what's been happening in your body and where you are right now, so I can guide you toward the most appropriate next step. There's no pressure and no commitment. This is a thoughtful starting point designed to bring context before we talk.

Birthday
Month
Day
Year
Filling this out for?
How did you find me?

Your Health Goals & History

What are your main goals for seeking Functional Nutrition Counseling? (Select all that apply)
What have you tried so far?

Nutrition & Lifestyle Snapshot

Which of the following are currently in your diet in any amount? (Check all that apply)
What percentage of your meals are home-cooked (versus takeout, dining out, or pre-made meals)?

 Your Readiness & Learning Style

Are you ready to start making aligned changes to support your health—with guidance and accountability? Your response will help determine the best next step for you.
How do you prefer to learn or be supported? (Check all that apply)
Have you completed the Health Root Reboot mini-course?

Brief Health Journey

(This could be about medications, stress, sleep, mindset, etc.)

This helps me understand where you're coming from and what matters most to you. Share as much or as little as you’d like, this is your safe space.


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