Ready to book in for GLP‑1 Nutrition Support?
Complete this form and I’ll get back to you so we can get it in the diary.
Name
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First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: 00000000000.
Which best describes your current situation with GLP‑1 medication?
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I’m already taking Wegovy
I’m already taking Mounjaro
I’m already taking Ozempic
I’m on a different GLP‑1 medication
I’ve been prescribed but not started yet
I’m considering GLP‑1 and doing research
How are you currently feeling about food and eating on GLP‑1?
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If our work together were really helpful, what would you most like to be different 3–6 months from now?
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Which areas feel most important for you right now?
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Knowing I’m eating enough on GLP‑1
Managing nausea, constipation or other side effects
Having a simple, sustainable meal rhythm
Emotional eating / stress or comfort eating
Guilt, shame or fear around food
Body image and self‑confidence
Navigating social events, holidays or travel
Worries about stopping or changing medication in future
Have you ever been diagnosed with an eating disorder, or are you currently receiving specialist support for eating or body image?
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Yes, currently
Yes, in the past but not currently
No
I’m not sure / not formally diagnosed
If you’d like to share more about this (optional), you can do so here:
Are there any medical conditions or medications (other than your GLP‑1) that you feel are important for me to be aware of before we speak?
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What have you already tried to support yourself around food, weight or health?
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On a scale of 1–10, how ready do you feel to have support around your relationship with food and habits right now?
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Not ready at all
1
2
3
4
5
6
7
8
9
Very ready
10
1 is Not ready at all, 10 is Very ready
Where did you hear about me?
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