Pre-Consultation Questionnaire Eatuitive Nutrition · Inside Evolve Strength About youStep 1 of 6 📍 Filled out this form recently? Feel free to skip this step. If it's been a while since we last saw you, please update your information below. Personal information Legal first name*Required Last name*Required Preferred first name(optional) Date of birth*Required Email address*Please enter a valid email Mobile phone*Required Home phone(optional) Gender(optional) Relationship status(optional) Select…SingleIn a relationshipMarried / Common-lawSeparated / DivorcedWidowedPrefer not to say Address Street*Required Unit(optional) City*Required Province / State*Required AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaOntarioPrince Edward IslandQuebecSaskatchewanNorthwest TerritoriesNunavutYukon Postal code*Required Country* Select…CanadaUnited StatesOtherRequired Work & referral Occupation(optional) Hours per week(optional) Referred by(optional) Your health & goals What are your main reasons / goals for booking?*Required Do you have any current or past medical conditions, diagnoses, or major health concerns we should be aware of?*Required — write "None" if not applicable What are your body composition goals, if any?* Lose fat & lose weight Build muscle & lose fat, weight stays about the same (body recomposition) Build muscle & gain weight None Other Please choose one Please describe*Required Looking ahead Think forward about 6 to 12 months. What would you like to see different about your health, body composition, fitness and nutrition?*Required What have you tried so far to accomplish these goals?*Required What is holding you back from achieving these goals?*Required Services & support Which services or disciplines are you interested in? (select all that apply)* Dietitian – Baseline Metabolism & Body Composition (Session 1: RMR + Body Composition testing) Dietitian – Nutrition Assessment (1-on-1 consultation) Dietitian – Ongoing Follow-Ups & InBody Re-Tests Physiotherapy – Specialized Running Gait Assessment (available late 2026; same day as Kinesiology-led VO2 max testing) Physiotherapy – Standard Assessment & Follow-Ups (injury rehab & mobility; submax testing available post-assessment if clinically indicated) Kinesiology – VO2 Max Testing (cardiovascular fitness & HR zone testing) Kinesiology – Clinical Exercise Sessions (personalized training-led) (coming 2027) Unsure / Multi-Disciplinary (recommend a combination based on my goals) Please choose at least one What level of support are you looking for?* Multi-Session Package (best value for structured progress) Pay-as-you-go (flexible, session-by-session check-ins) Start with 1 session (apply session fee toward a package if you upgrade by end of session day) Please choose one Are you interested in joint sessions for couples programs?* Yes No Please choose one Insurance & benefits Are you claiming Extended Health Benefits and/or Spending Accounts (Health / Wellness)?* Yes – Extended Health Benefits Yes – Spending Account (Health / Wellness) No Please choose one Insurance provider*Required Employer offering the plan*Required Are you the primary or secondary policy holder?* Primary Secondary Please choose one Plan details Yearly coverage amount*Required % covered*Required Policy renewal date*Required Anything else you'd like to share with us?(optional) Something went wrong sending your form. Please try again, or contact the clinic directly. Back Next Submit ✓ Thank you! Your questionnaire has been received. We'll review it before your consultation.
