Introductory Assessment Form

Thank you for dedicating time to fill out this questionnaire. Your responses will guide our discussion, allowing us to delve deeper into your needs and determine the support required to help you achieve your goals.

Part A: Areas Of Interest

Please Tick The Areas Of Women’s Nutrition That Are Of Interest To You:


Part B: Are You An Emotional Eater?

Part C: Could It Be Binge Eating?

Part D: Are You Struggling with Body Image and Food Control?

Please tick the ones that seem relatable to you.