Health & Nutrition Needs Question Title * 1. Gender Female Male Question Title * 2. Age Question Title * 3. Which of the following conditions are you dealing with, if any? Check all that apply. Autoimmune disease Digestive issues Thyroid issues Mood/cognitive issues (depression, anxiety, ADHD...) Skin conditions (eczema, psoriasis, acne...) Fatigue Resistant weight loss None of the above Other (please specify) Question Title * 4. Do you follow (or are trying to follow) any type of special diet now? Check all that apply. Gluten-free Dairy-free Soy-free Paleo/Autoimmune Paleo Vegetarian/Vegan Low FODMAP Other (please specify) Question Title * 5. How much do you enjoy/are you able to cook your own meals? (1 - "Where IS my kitchen?", 4 - "I live for making most of my meals from scratch." 1 4 Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 6. Which type of nutrition guidance have you utilized, if any? Check all that apply. I am seeing/have seen a dietitian/nutritionist or other practitioner for one-on-one nutrition consulting I am part of/have been a part of a group course or program on nutrition (live or on-line) I am have researched nutrition on my own through books/blogs/other media. No formal guidance. I am brand new to learning about nutrition, I haven't sought out any information Other (please specify) Question Title * 7. What are your biggest sources of frustration when trying to eat healthfully/change your lifestyle? Question Title * 8. Based on the list below, rank the strategies you want to learn MOST about to improve your health? (1 - Most, 10 - Least) 1 2 3 4 5 6 7 8 9 10 How to determine which diet you should be following for your specific condition 1 2 3 4 5 6 7 8 9 10 How to follow a diet that eliminates food sensitivities (e.g. gluten, dairy, corn, soy, grains, etc.) 1 2 3 4 5 6 7 8 9 10 How to shop for food - e.g. reading labels, product recommendations 1 2 3 4 5 6 7 8 9 10 How to prepare food/recipes 1 2 3 4 5 6 7 8 9 10 Ideas for eating out/social situations 1 2 3 4 5 6 7 8 9 10 How to work with your doctor (e.g. questions to ask, which lab tests) 1 2 3 4 5 6 7 8 9 10 Which supplements to take 1 2 3 4 5 6 7 8 9 10 Strategies to maintain a healthy weight 1 2 3 4 5 6 7 8 9 10 How to improve stress management, sleep 1 2 3 4 5 6 7 8 9 10 How to use non-toxic home/personal care products Question Title * 9. Ideally, how would you most prefer to learn about nutrition & health strategies? Choose one. Individual, one-on-one consultation (in-person or remote by phone or videoconference) An on-line, self-paced educational course A membership site to visit on your own time with well-vetted health information and advice A combination of an on-line course, membership site and individualized advice/Q&A Other (please specify) Question Title * 10. Is there anything else you'd be willing to share about your health & nutrition goals/struggles/challenges so I can serve you even better? Done