Supplement Coaching ASSESSMENT BY Kristi Littau Holistic Integrative Nutritionist
Mind Body You, LLC
Name
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First Name
Last Name
Email:
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Age:
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Describe your overall health goals!
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Describe overall skin and hair condition:
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Current medications:
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Current over the counter or Supplements:
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How much sunlight do you get and at what time:
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Do you experience bloating or indgiestion shortly after eating?
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Have you ever taken any nutraceuticals or gym supplements if yes name them AND HOW DID YOU FEEL TAKING THEM:
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Are you currently on an exercise or training regimen? If so, please explain:
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Are your menstruation cycles regular (female clients only)
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Yes
No
Do you suffer from PMS(female clients only)
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Yes
No
Do you suffer from anxiety,stress or tension?
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How are your energy levels throught the day?describe
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How much water do you consume daily?
*
Assessment complete!
I will be in touch within 2-3 business days with your supplement assignment package.
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