Intake Questionnaire

Step 1 of 5: About You

First name

Email address

Age

Which plan are you starting with?

Sex assigned at birth Used to build your personalized nutrition targets

Height

Current weight No judgment, helps me build the right targets

Step 2 of 5: Your Goals

What brought you here? Be as honest as you want. No wrong answers.

What does feeling good in your body actually look like for you? Not aesthetics: how you want to FEEL day to day

What are you most hoping to change about your relationship with food?

What have you tried before that hasn't worked, and why do you think it failed?

Step 3 of 5: Your Lifestyle

How would you describe your current activity level?

Mostly sedentary: desk job, not much movement outside of daily life Lightly active: I walk, maybe exercise once or twice a week Moderately active: I exercise 3-4 times a week consistently Very active: I train hard 5+ days a week

What kinds of movement do you enjoy (or want to enjoy)?

How many hours of sleep do you typically get?

How would you rate your current stress level?

What does a typical weekday look like for you? Helps me understand when and how you're actually eating

Step 4 of 5: Your Food Story

How would you describe your current relationship with food?

At war with it: food feels like the enemy most days Complicated: some days fine, some days a spiral Neutral: I don't think about it much but know it could be better Mostly good: I just want to optimize and understand it better

How many times a day do you typically eat?

How comfortable are you in the kitchen?

Any dietary restrictions or allergies I need to know about?

Foods you absolutely will not eat

Anything about your health history that might affect your nutrition? PCOS, thyroid conditions, digestive issues, medications: share what feels relevant

Step 5 of 5: Last Things

What's your biggest fear or concern going into this? The fact that you have one is normal. Let's name it.

What do you most want to feel different in 3 months?

How did you find Levity?

Anything else you want me to know before we start?

Step 1 of 5

I've got you.

Your intake is in. I'll be in touch within 1 business day to talk through next steps and get your plan started. Check your inbox, and check your spam just in case.

Intake Questionnaire

Tell me about you.
The real version.

I've got you.

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Intake Questionnaire

Tell me about you.The real version.

I've got you.

Tell me about you.
The real version.