build your foundation intake questionnaire

AllieFitFoodie Services

Congratulations on taking the NEXT big and challenging step to improving your health and wellness! That step is committing to work together longer term to address your health and wellness goals. 

Before you complete the intake form below, know that:

  • All of the information you share in this form (as well as during our conversation) is kept confidential and will help me know how I can best serve you.

  • The intake form is thorough on purpose because it asks questions your doctor likely never has, and it makes you think about things that are keys to piecing together the puzzle of your unique story. This allows me to customize what we do for your individual needs, and it is the basis of forming our action plan going forward.

What else you should know:

  • Sessions are virtual (we can connect and work together no matter where in the world you may be), and we can talk via phone or use a video option such as Skype, or FaceTime.

  • I do not take insurance.

  • Fees must be received prior to our session(s).

  • Fees paid for sessions, packages, programs and/or other services are nonrefundable. If you have questions please contact me first for clarification.

    • You can also email me at, or call me at 818-571-8485.

Please fill out your answers to the questions below as openly and honestly as possible, and then click submit. IMPORTANT: Before you navigate away from the page, please make sure the message "Thank you..." appears. This means your form was appropriately submitted.


Name *
Address *
Phone *
This phone number is my (please check one): *
Preferred method of contact: *
Sessions are virtual, select your preferred method to conduct our session. *
Gender *
How much time have you taken off from work or school in the past 12 months because you didn't feel well? *
Do you experience any of the following symptoms? Check all that apply. *
Bowel movement frequency *
Which of the following foods do you consume regularly? *
How often do you participate in social activities with others? *
Women only, please check all that apply
I give permission for Jennifer Caryn Brand Nutrition to use my case for marketing purposes. Names will be kept confidential, and details of the case may be changed for privacy. *

Thank you for taking the time to fill out the intake questionnaire.


Please complete (sign/initial) my on boarding forms.


Please schedule your intake session, and pay for your program via the calendar below.


I'm excited to work with you!


Clinical Nutritionist