New Client – Intake New Client – Intake formPlease enable JavaScript in your browser to complete this form.Name *FirstLastEmail address *Current Weight (Pounds) *Height (Feet and Inches) *Describe any medical conditions you currently have. *List any medications or supplements that you are currently taking. *List any food allergies or senstivities. *What are your top 3 health concerns? *How many people do you grocery shop for? *How much (on average) do you usually spend on groceries per week? Selected Value: 0 How many times per week do you eat food from a restaurant? *Describe your health, fitness and/or sports performance goals. *Do you currently follow a specific eating philosophy or type of diet? If yes, describe it. *Describe a typical breakfast. *Describe a typical lunch. *Describe a typical dinner. *How often do you snack per day and what types of snacks to you typically eat? *How often do you consume alcohol? *NeverOnce in a whileA few times per monthA few times per weekAt least once a dayHow often do you smoke cigarettes? *NeverOnce in a whileEverydaySubmit