PRISM Nutrition Coaching Form
Please answer all questions in as much detail as possible, to help ensure that we're a good fit.

I'll be in touch within 2-3 working days, and rest assured your answers will never be shared with any third party.
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Email *
Name *
Gender *
Age *
Phone number *
Your weight in kilograms *
Your height in metres
Please describe any medical issues that could impact diet and exercise (e.g. diabetes, PCOS, thyroid) *
Any food allergies or intolerances?
What's your occupation? Describe your activity level (e.g. desk-based or active). Is it a high stress job?
What type of coaching are you looking for? The investment for on-going coaching programmes starts from £699. *
What is your primary goal? Select ONE only. *
Please expand on your primary goal, quantifying your targets/expectations/previous experiences. If you have any secondary goal(s) in mind, please feel free to expand on this too. *
Do you have a specific time-frame in mind as to when you'd like to achieve this? *
In very simple, practical terms, what is preventing you from already having achieved your goal? For example, time, willpower, nutritional knowledge, portion control, food choices, cooking skills, exercise etc. *
What's motivated you to make this change now? *
What do you expect from me as your nutrition coach? *
Are you currently training/exercising consistently?
Clear selection
What exercise/activity are you doing regularly now? Weight lifting, cycling, running, etc. How frequently do you do this? *
Do you use an activity tracker that counts your steps? If so, what is your average step count over the past 7 days and past month?
Lastly, where did you hear about PRISM Nutrition?
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