Pre-appointment questionnaire

Personal Training: Available 7 days per week (bookings essential). Ph Col 0428 528 333

Nutrition Consultations: Available Monday to Friday. Some Saturday appointments.

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.

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Please let us know your name.
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Contact Details
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Please let us know your email address.
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Please tick the box to agree to our Cancellation Policy, thank you.
Cancellation policy: In order to provide the best possible service, Coffs Coast Nutrition allocates up to 60 minutes for an initial consultation & 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 ask you to provide at least one full business day’s 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 $30 cancellation fee. If for any reason you are running late for an appointment, please call to let us know.
We understand that emergencies do sometimes occur, and in this situation we may consider waiving the cancellation fee.
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If you wish to see Louise, please complete the following pre-appointment questionnaire.

If you would like to see one of our other Nutritionists, you will not need to complete this part of the questionnaire, just 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
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Fruit and vegetables
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Dairy and alternatives
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Bread and cereals
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Meat, fish, chicken
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Vegetarian options
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Fats & oils
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Other
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How much time do you have available for meal preparation per day?
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List the type & amount of exercise that is carried out
Walking
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Swimming & aqua-fitness
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Cycling
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Golf
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Provide examples of the FOODS and DRINKS you consume at each meal and snack. No need to list water.
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Please tick the Security Check box, thanks!