Make an Appointment

Personal Training: Available 7 days per week (bookings essential). Ph Col 0428 528 333 and leave a message. This number is for personal training and AlterG enquires only.

Nutrition Consultations: Available Monday to Friday. Some Saturday appointments. Ph: (02) 6652 7529 and LEAVE A MESSAGE to let our receptionist know the best day and time to call you.

If you would like to see one of our Nutritionists, please answer the following questions and we will get back to you with an appointment day and time.

Title:(*)

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Full Name(*)

Please let us know your name.

Address:

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Date of Birth

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Occupation:

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Contact Details

Mobile phone:

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Home phone:

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Work phone:

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Email address:(*)

Please let us know your email address.

What is your best contact?

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What days and times can you attend an appointment? If you can be fairly flexible this will give you the best possible chance for an earlier appointment

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Main reason for seeing us:

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Symptoms

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Other Medical Conditions

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List medication

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List vitamin, mineral and herbal supplements (and manufacturer - if known)

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List protein powders, sports products and weight loss products (and manufacturer - if known)

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How did you hear about us ?

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Payment and cancellation policy (required)(*)

I have read, understood and agree to be bound by the terms and conditions of Coffs Coast Nutrition’s payment and cancellation policy (below). Please tick the box to agree to our Cancellation Policy, thank you.

Payment and cancellation policy: ** We require full payment for telehealth consultations (phone and video / zoom) at least 24 hours prior to your appointment. ** In order to provide the best possible service, Coffs Coast Nutrition allocates up to 60 minutes for an initial consultation and 20-30 minutes for review consultations. We can only maintain this level of service if our clients provide sufficient notice when unable to attend. This allows us to offer the time slot to someone else requiring an urgent / earlier appointment.
For this reason we require at least 24 hours notice if you are unable to attend or need to reschedule. Appointments cancelled on the day of the appointment and no-show appointments will incur a $55.00 fee (initial consults) or $30.00 (review consults). This includes consultations carried out at Coffs Coast Nutrition as well as telehealth (phone or zoom / video) consultations. If for any reason you are running late for an appointment, please call to let us know.
We understand that emergencies sometimes occur, and in this situation we may consider waiving the cancellation fee.

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Please do NOT fill in the following section UNLESS you would like to purchase an individually tailored MEAL PLAN. Prices for meal plans will vary depending on factors such as length of plan (eg weekly or fortnightly) and whether you have complex dietary requirements .

If you do NOT want an individually tailored meal plan, you will NOT need to complete this part of the questionnaire. Simply scroll to the bottom, tick the security check and click the Send button.

If you are having trouble filling in the questionnaire, please phone Coffs Coast Nutrition on (02) 6652 7529 and our receptionist will help you.
You will need to leave a message if the phone is unattended.

Select the appropriate box to indicate approximately how often each item is consumed:

Fluids

Fruit Juice

Sweet Drinks
(soft drink, cordial, sports drink)

Diet Drinks

Tea, Coffee

Alcohol

Fruit and vegetables

Fresh fruit

Tinned fruit

Dried fruit

Starchy Vegetables
(eg potato, sweet potato, corn)

All other vegetables, salad

Dairy and alternatives

Milk (cows) full cream

Milk (cows) skim, lite

Milk
(soy, almond, rice, coconut)

Milk (flavoured)

Yoghurt (Greek)

Yoghurt (lite)

Yoghurt (diet)

Ice cream, dessert

Cheese

Cottage, ricotta cheese

Bread and cereals

Bread (grain)

Bread (sourdough)

Bread
(wholemeal, rye)

Bread (white)

Bread
(flatbread, wrap)

Crispbread, crackers

Breakfast cereal, please list below

Cereals

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Rice, pasta, quinoa etc

Meat, fish, chicken

Red meat
(steak, chops, mince)

Pork

Chicken, turkey

Salami, cabanossi

Pie, sausage roll

Sausages, bacon

Fish (canned)

Fish (fresh)

Eggs

Vegetarian options

Legumes
(eg kidney beans, chick peas, baked beans, lentils)

Tofu, miso or tempeh

Nuts, seeds

Fats & oils

Olive oil

Coconut oil

Avocado

Butter, margarine

Cream, sour cream

Other

Take away food
eg hot chips, burger, pizza, Chinese, Thai etc

Commercial sauces, gravy, mayo

Lollies, chocolate, crisps, biscuits, cake, pastries etc

Muesli bars, protein bars

Protein drinks or meal replacements

Other (please list below)

Others

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How much time do you have available for meal preparation per day?

During the week

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On weekends

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List the type & amount of exercise that is carried out

Walking

How often?

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Time spent per session?

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Swimming & aqua-fitness

How often?

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Time spent per session?

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Cycling

How often?

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Time spent per session?

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Golf

How often?

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Time spent per session?

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Other (please list)

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How often?

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Time spent per session?

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Provide multiple examples of the FOODS and DRINKS you consume at each meal and snack. There is NO need to list water.

Breakfast

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Snack

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Lunch

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Snack

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Dinner

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Snack

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Security Check(*)

Please tick the Security Check box, thanks!

Pre-appointment questionnaire

If you would like to see one of our Nutritionists, please answer the following questions and we will get back to you with an appointment day and time.

Please do NOT fill in the following section UNLESS you would like to purchase an individually tailored MEAL PLAN. Prices for meal plans will vary depending on factors such as length of plan (eg weekly or fortnightly) and whether you have complex dietary requirements .

If you do NOT want an individually tailored meal plan, you will NOT need to complete this part of the questionnaire. Simply scroll to the bottom, tick the security check and click the Send button.