Private Coaching with Ti – Intake Form

Initial intake form for exploring private coaching with Ti Caudron, PhD. Please note: Ti Caudron, PhD is a nutrition and weight loss coach and not a medical doctor. Please relay all medically related questions to your healthcare practitioner.

Step 1 of 3

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  • Please use the + button to add rows as needed for each additional child.
    GenderAgeYes, Lives at HomeNo, Does Not Live at Home 
    Add a new row
  • Please list your known Medical Conditions (e.g., high blood pressure, diabetes, elevated blood sugar, cholesterol, high LDL, low HDL, elevated liver enzymes, cancer, food allergies or sensitivities etc.) — Use the + button to add additional rows as needed (up to 15) — This information will be kept confidential!
    Add a new row
  • Describe how you normally eat. Check the boxes for all that apply.
  • Please name which programs or eating styles you have tried and the results you have achieved. For example: lost weight, medical changes, sleep, energy, mental clarity, cravings, or other.