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Lifestyle Changes/Weight Loss
Food Sensitivity Testing
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By appointment only

Please fill out the following form completely to be contacted for an appointment. Thank you.

What prompted you to reach out to me for help?

At this time, are you currently using MyFitnessPal or any other app to log your food?

Yes

No

What are your biggest challenges or obstacles with your nutrition?

Have you even seen a dietitian before?

Yes

No

If no, are you open to learning how to do this?

Yes

No

On a scale of 1 to 10, how committed are you to your personal nutrition goals?

Your health is your wealth.

Thanks for investing.

©2017 by A Stapel in Wellness. Website content is provided for educational purposes only and is not intended to be diagnostic.

Sarah Stapelmann MS, RDN, LD, CLT