support group survey | Walker's Functional

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WALKER'S FUNCTIONAL NUTRITION, based in Northampton, MA

Empower yourself naturally through diet and lifestyle

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jeanette@walkersfunctionalnutrition.com

(413) 695-4564

Support Group Questionnaire

Select a date

First name

Last name

Email

Phone #

Functional Nutrition Counseling can heal many health conditions. Please indicate what illness categories are of most interest to you. * Required

Brain Health (ADHD, Alzheimers, brain fog)

Mental Health (anxiety, depression, Bipolar D/O)

Autoimmunity( RA, Psoraisis, Hashimotos, Lupus, Crohns)

Digestive disorders (acid reflux, bloating, constipation, gas, IBS)

Arthritis

Please indicate what types of educational support group in each of the different lifestyle categories that you are interested in.

1. Non negotiables for healing diet (elimination of the top three most inflammatory foods in western diet)

sugar

most interested

moderately interested

least interested

gluten

most interested

moderately interested

least interested

dairy

most interested

moderately interested

least interested

From a scale of 1-3 please list which groups you are interested in each lifestyle section.

DIET

2. How to add more antioxidant support in my diet to combat oxidative stress and eat more vegetables (pre and probiotic fibers) needed for healing and learn more about healthier food swaps to incorporate indoor diet.

I need help with meal planning on a whole food diet and batch cooking makes being on a wellness diet more doable.

How to socialize on a wellness/healing diet

SLEEP

3. Why is sleep so important and how can I get more restful and deep to sleep to ensure my brains detoxification system is working.

What are strategies to help get to sleep.

What are strategies to help me stay asleep.

MOVEMENT

4. Support for daily movement, whatever that may look like given your current energy and fitness need levels

I would be interested in an explorative zoom dance or movement class to get out of my head and into my body.

Why is movement so important to keep us healthy and strategies to incorporate more movement in my daily life.

SOCIAL SUPPORT/NETWORKS

5. I’d like to explore ways I can have greater connection with others that feels meaningful.

I’d like to have certain topics discussed so we can have open dialogue and support each other through community care and connection.

I’d like a forum where participants can share what obstacles get in the way of healthy relationships and learn skills from each other about what has worked to create healthier connections ( i.e., boundary setting, communicating needs effectively)

STRESS & RESILIENCE

6. I want to learn and practice stress management techniques.

I want to learn what the vagus nerve is and how to stimulate my vagus nerve to aid in accessing the para-sympathetic response needed to relax.

I want to learn how stress busts the gut and learn strategies to improve my digestion by simple food hygiene techniques.

MIND/BODY/SPIRIT

7. How does somatic work (Soma means body in Latin, so somatic means of the body and is most often used in connection with one's health) help us heal the trauma we hold in our bodies anyhow to encourage doing it on a daily practice

I’d like to learn and practice breathing and mindfulness practices and/or guided meditations

I’d like to work on and get support for mindset issues that do not serve my growth. (Negative self talk that just won’t quit)

REDUCING TOXIC LOAD

8. I want to be more aware of the toxic chemicals in my everyday environment that maybe contributing to my illness.

I want to learn more about what chemicals are important to eliminate in the foods I am eating.

I want to learn about clean brands to use that support my wellness.

Are you interested in being contacted about a support group to help you modify your diet and lifestyle for greater health?

yes

no

Thanks for submitting!

Contact

(413) 695-4564

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