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  • Whole30 Coaching Intake Form

  • Hello!  

    I am excited about the opportunity to work with you! 

    Now, let's get to know each other.  This form has a lot of questions so make sure you have 20 minutes (ish) to complete it.  I've tried to leave you plenty of room, so let the answers flow! The more I know about your own personal journey, the better I can support you.  

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    Pick a Date
  • The Whole Pickle Whole30 and Food Freedom coaching services are intended to promote general health and wellness and are not intended to replace physician care or medical intervention. All nutritional assessments, suggestions, and/or consultants on health, nutrition, diet, and lifestyle are based on your input and are not intended to diagnose, treat, or cure any disease or ailment. You acknowledge your responsibility for reviewing any diet, lifestyle, or nutrition suggestions with your primary care physician or another licensed medical professional before following said suggestions. As with any program, there may be inherent risks that may be relative to your state of health, fitness, awareness, care, and skill to which you conduct yourself. You agree that it is your responsibility to inquire about any recommendations with which you are unfamiliar and to provide The Whole Pickle with any information which may limit your participation in the Whole30 program. 

    Results and changes in your general health and wellness may vary depending on medical conditions, medications, your adherence to the guidelines, and bio-individuality. As your general health and wellness may change with any modifications to your diet, nutrition, and lifestyle, physician-prescribed medications may require modification. It is your responsibility to discuss this with your physician. Never reduce or eliminate physician-prescribed medications without discussing it with your physician or health care provider.

    Your personal and health information will remain confidential and will not be shared without your consent. Cyndy and The Whole Pickle reserve the right to refuse services to any individual. 

    By clicking that you agree below, you acknowledge that you have read that above disclosure about the coaching services offered by Cyndy at The Whole Pickle. I understand that Cyndy is not a licensed physician and that these coaching services are not licensed by the state, medically authorized, or sponsored by any licensing bodies. I acknowledge that it is my responsibility to maintain a relationship with my primary care physician or another licensed medical provider. I consent to use the services provided by Cyndy at The Whole Pickle and agree to be personally responsible for the fees in connection with the services provided to me.  I agree to the above terms and conditions for participation in Whole30 or Food Freedom coaching with Cyndy at The Whole Pickle. 

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