Goals and Readiness Assessment

Here we'd like to talk a little about why you signed up for your visit today
Reason to visit dietitian

Reason to visit dietitian

Food and nutrition goals

Food and nutrition goals

Three habits you wish to change about health and nutrition

Three habits you wish to change about health and nutrition

Challenge(s) to reach nutrition goals

Challenge(s) to reach nutrition goals

Past techniques, diets, behaviors, etc. to reach your nutrition goals

Past techniques, diets, behaviors, etc. to reach your nutrition goals

Willingness to do the following (1 - not willing to 5 - very willing)
1 2 3 4 5
Significantly modify your diet
Take nutritional supplements each day
Keep a record of everything you eat each day
Modify your lifestyle (ex: work demands, sleep habits, physical activity)
Practice relaxation techniques
Engage in regular exercise/physical activity
Have periodic lab tests to assess your progress
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Willingness to do the following (1 - not willing to 5 - very willing)
1 2 3 4 5
Significantly modify your diet
Take nutritional supplements each day
Keep a record of everything you eat each day
Modify your lifestyle (ex: work demands, sleep habits, physical activity)
Practice relaxation techniques
Engage in regular exercise/physical activity
Have periodic lab tests to assess your progress
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