A rustic Coffee mug sits on a brown book, with journal pages open in foreground. Books and mug are places on a wrinkled blanket

Client Intake Form

Complete our form with your details. Be as specific as possible, as this helps guide the coaching conversation. No payment will be due or collected until your appointment is scheduled and confirmed.

Three avocado halves filled with chopped vegetables, pomegranate seeds, crumbled cheese, and herbs on a beige fabric napkin.
Beautiful blueberries and red raspberries in a dish

Intake Form Instructions

This intake form will take approximately 10-25 minutes to complete. Please ensure you do not refresh the page, as doing so will result in the loss of your answers. Once you have filled out the form, be sure to click the "submit" button to finalize your submission. Thank you.

Additional Information

  • Payment: Eat For Health requires payment in full prior to all appointments. We do not issue refunds for no-show or late appointments.

  • Cancellation Policy: To cancel or reschedule, please do so at least 1 day in advance. We do not issue refunds for same-day cancellations.

  • Location: Consultations are offered virtually to any location worldwide, or in-person (See meeting locations in New Paris, Ohio or Richmond, Indiana).

  • Preparation: To make the most of your appointment, We ask that you arrive 15-20 minutes early for in-person appointments or 5 minutes early for virtual coaching.