Instructions: This from will provide us with information used to develop your personalized program. Please answer all questions as accurately and concisely as possible. If you partially complete the form you can stop and shut it down. If you come back to it later, using the same computer and browser, you can pick up where you left off. You can hover your mouse over some questions for more detailed instructions.
Disclaimer: Please recognize that it is your responsibility to work with your physician before, during, and after seeking nutritional guidance. Any such guidance provided is not to be followed without prior apporval of your physician. If you choose to use this information without the prior consent of your physician, you are agreeing to accept full responsibility for your decision.