2 minutes to complete
The consent form must be filled out by the parent/guardian of a child who wishes to enroll in the Nutrition program. If the child is 18 years or older, he/she must be the one to fill the form.
How do you prefer to receive information about nutrition? (i.e. pamphlets, online, etc.)
What are your preferred methods of communication? (i.e. phone, email, text)
How often would you like to receive updates on your progress?
What is your current nutritional knowledge?
What are your current eating habits?
What are your current physical activity levels?
What are your current weight and height?
What are your current health goals?
What are your current medical conditions?
Are you pregnant or breastfeeding?
Do you have any food allergies or sensitivities?
Do you have any religious or cultural dietary restrictions?
Do you have any other concerns or questions?
Do you give your consent to sign up for this nutrition program?
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