PCOS Initial Appointment Assessment

Client Assessment Form

Thank you for taking time to complete this assessment questionnaire. The assessment will help me decide what we may need to explore in greater detail and what changes would make the biggest difference to achieving your goals.
Current physical activity levels    
Please note down your usual planned and unplanned physical activity. Record intensity levels using L for low intensity, M for moderate & V for vigorous intensity. Examples include walking or cycling to work, housework, and gardening.
Stress Levels
How high are your levels of stress at present? (0 = no stress; 10 = very high stress impacting work/relationships)
Diet Diary
Your Relationship with Food
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