Mindful Nutrition Assessment

Thank you for your interest in the Lotus Theory Mindful Nutrition. This program is meant to be an introduction to holistic healthy living and is meant to jumpstart an entirely new lifestyle for you to enjoy for years to come.

These questions assess whether the Lotus Theory Mindful Nutrition is right for you.

Please take a few minutes to complete the questions below.

First Name

Last Name

You aren’t eligible for the Mindful Nutrition at this time - Find out why

Have you ever struggled with low self-esteem?

Yes

You aren’t eligible for the Mindful Nutrition at this time - Find out why

Do you want to eat healthier, but don’t know where or how to start?

Yes

You aren’t eligible for the Mindful Nutrition at this time - Find out why

In a few words, how are you hoping to FEEL after completing Lotus Theory Mindful Nutrition?

Your Lotus Theory Clinician Name