Fit in 15! Nutrition consult charting form This is a nutrition consult form for Rachel to fill out during her call with clients. Fit in 15! Nutrition CounselingName* First Last Phone*Email* Truck # (if you want us to contact you via QC messages/reminders) I will send you a summary and goal list of what we talk about today. How do you prefer me to contact you and send you that info?* Email Phone QualComm What type of driver are you* PSD TNT Trainer solo driver team driver in-house Assessment/Engaging Engage – build rapport, use open ended questions, uncover values and hopes, offer compassionate value-based reflections maintaining curiosity about your client --Type any relevant info for the ENGAGING sectionIn general, what are your goals?* Lose weight/fat Learn how to make better nutrition habits Gain weight Learn more about nutrition Maintain weight Add muscle Improve physical fitness Look better Feel better Have more energy and vitality Get control of eating habits Get stronger Check all that apply.Out of all the above goals, which ones feel the most important/urgent? And why? Do you have a past Hx of trying to reach that goal?*Have you been diagnosed (currently or in the past) with any significant medical conditions and/or injuries and do you have any medications, either OTC or RX that interact with your lifestyle?* Yes No List conditions/ diagnoses and meds if applicableRight now, how would you rank your overall eating, nutrition habits?*ExcellentPretty goodNeutralNot so greatTerribleAre there any foods you will not eat because of intolerances or allergies? Are there any foods you will not eat because you dislike them?*What is a typical day of eating look like for you lately?*Typical fluids*How is your stress and recovery?On average, how many hours per night do you sleep?* 4 or fewer hours 5 hours 6 hours 7 hours 8 hours 9 hours 10 hours How do you normally cope with your stress?Summary of call to review with clientFill out summary box below, this will guide you in guiding client on what to fill out in SMART goal formSummary of SMART goal(s) and main benefits of achieving itSummary of action steps to take to reach the goal(s)
