Slim & Healthy Class
Questionnaire

Please take a moment to fill this out.

Your answers to this questionnaire will help me to focus the class material to meet your needs as effectively as I can. Be sure to click "submit" when you're finished.

Thanks so much and I really look forward to meeting you in our first class.

Do you want to lose weight? If so, about how much?

Do you have any current health problems? Please describe.

Have you taken a cooking & nutrition class from me previously? Which one(s)?

Do you have any food allergies or sensitivities? Please list them.

Are you currently eating a plant-based diet?

Have you eaten a plant-based diet at any time in your life?  If so, what was it like for you?

Have you ever quit eating a plant-based diet, why did you stop?  What were the challenges?

Please choose the one that feels the most true for you...

What do you hope to get out of this class?

How did you hear about the class?

Important Disclaimer:  This class is not intended as medical advice.  The information provided in the class and handouts is for educational purposes only.  Food is very powerful, and changing your diet will have an effect on your health.  If you are on medications, be sure to work with your health care provider as your medications may need to be adjusted, reduced, or eliminated.  Do NOT make changes in your medications without consulting  your health care provider.  DO let your health care provider know if you make changes to your diet.

I have read the above disclaimer and take full responsibility for my choices and any consequences of my choices. (Type your name in the box.)

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