Pre-appointment questionnaire (for Louise's clients only)

We have 3 Nutritionists. If you wish to see Louise, please complete the following pre-appointment questionnaire. 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.

If you would like to see one of our other Nutritionists, you will not need to complete the questionnaire.

Select the appropriate box to indicate approximately how often each item is consumed:
Please let us know your name.
Please let us know your email address.
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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What types of food & drinks do you consume (no need to list water)
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Please enter these characters
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