Pre-Assessment

This pre-assessment is designed to help me understand your relationship with food and your body, so I can offer the most effective and supportive coaching experience for your journey.

All information you share is completely confidential. At this stage, we'll only ask for your first name (or known name) and contact details.

*Please note that this programme is currently available only to individuals residing in the United Kingdom. By completing this form you are agreeing to be contacted by email regarding coaching sessions with The Wellbeing Nutritionist, and ageee to our privacy policy.

First name

Email address

Phone number

Current Relationship with Food

How would you describe your current relationship with food?

What food-related challenges do you currently experience?

Please could you tell me a little bit about your relationship with food.

Body Image & Self-Perception

How would you describe your current body image?

What specific body image concerns would you like to address?

Goals & Motivation

What are your main goals for our coaching work together?

What is your primary motivation for seeking coaching support?

Improve mental health and wellbeing

Break free from diet culture

Develop food freedom and intuitive eating

Build body confidence and self-acceptance

Heal from disordered eating patterns

Support overall life balance and happiness

Other motivation

Background & History

Please share any relevant background or experiences that might be helpful for me to know

Support & Preferences

What type of coaching approach resonates most with you?

Gentle, compassionate guidance

Structured plan with clear steps

Mindfulness and intuitive approaches

Evidence-based and educational

Combination of multiple approaches

What support tools would be most helpful for you?

Is there anything else you'd like me to know or any questions you have about the coaching process?

Please confirm that you are currently living in the United Kingdom, and the majority of coaching will take place in the UK.

I confirm that I live in the United Kingdom