PRE-APPOINTMENT ASSESSMENT

APPOINTMENTS with Becky

Please complete the following form at least 2 days before your nutrition appointment. It gives us a better understanding as to your goals, relevant health conditions, medications or supplements etc. It allows for a more targeted assessment during our session and time spent on discussing the next steps.

Food Diary - Keeping one for 3-7 days before your appointment can be very helpful for the assessment during your appointment. The format could be on on paper, digital or photos. When keeping your food diary try not to change your usual food intake or routine; we’re not the food police and no-one eats “perfectly”. If you are coming to see us for gut or digestive issues, please record your symptoms on the food diary too, e.g. bloating, sore stomach, diarrhoea etc.

If keeping a food diary is too triggering, i.e. you are seeing us for support with your eating behaviours or disordered eating, please just let us know.

Name

First Name

Last Name

Occupation

Goals for Nutrition Appointment

List up to 2 Main goals e.g. Help fuel my swimming training and understand recovery nutrition better etc.

Medical Conditions & Current Medications

Brief description e.g. Asthma - Inhaler

Blood Tests (relevant to your reason for seeing us)

Record details here OR bring them along

General Wellness & Sleep

E.g. Usually healthy. Solid 8 hours sleep at night

Nutrition Supplements, including Vitamins & Minerals

Type, Brand, and How often Taken

Dietary Allergies or Intolerances

Diagnosed or Suspected

Exercise or Training Programme

Briefly describe your weekly exercise or training schedule OR bring along your Training Programme