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Midlife Diet Diagnostic

Welcome!


Please complete the following form so I can get started with your Midlife Diet Diagnostic!

At the end of this form, I'll ask you to upload a Word or Google Doc with a 3-day diary (I prefer 2 weekdays and 1 weekend day to give me a more complete picture to work with).

Please include:
  • All food plus the time of day consumed
  • Time of waking and going to bed
  • If you exercise, please provide the time of your exercise
  • Any supplements your currently take
Name(Required)

Please upload your document containing the items requested at the beginning of this form.

If you use a tracker like MyFitnessPal, you're welcome to share that data with me directly at mary@fuelbetterformula.com.

Max. file size: 64 MB.
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Copyright © 2018 Mary Miller Brooks, M.Ed. | Sustainable Nutrition. All Rights Reserved.
DISCLAIMER OF HEALTH-RELATED SERVICES: The information provided in my programs and services is not intended to be a substitute for professional medical advice, diagnosis or treatment that can be provided by your own Medical Doctor. I, Mary Brooks, am not holding myself out to be a Medical Provider (including doctor/physician, nurse, physician’s assistant or any other health professional), Mental Health Provider, registered dietitian or licensed nutritionist. Understand that Mary Brooks is not providing healthcare, medical or nutritional treatment therapies and I do not diagnose, treat or cure in any manner any disease, condition or ailment of the body .Rather, I serve as a trainer, educator, coach, mentor and guide who provides training, education, support, resources, guidance and information.