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Postpartum Collective VIP Assessment

This intake helps me understand your postpartum stage, feeding method, goals, struggles, movement, and nutrition so I can create a safe, personalized plan that supports weight loss without hurting your milk supply.

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Question 1 of 22

Full Name

Question 2 of 22

Age

Question 3 of 22

Height

Question 4 of 22

How many weeks or months postpartum are you?

Don't just write "7" — for example, say "7 weeks" or "7 months."

Question 5 of 22

Current Body Weight

Question 6 of 22

Goal Body Weight

Question 7 of 22

What are your top 2 or 3 other goals for postpartum health/wellness?

Question 8 of 22

What are your top 2 or 3 struggles or concerns for postpartum weight loss?

Question 9 of 22

Are you breastfeeding?

A

Yes

B

No

Question 10 of 22

If you are breastfeeding, do you know how many ounces of breastmilk you produce per day?

For example, does your baby get all of their nutrition from you, or do you do combo feeding with formula or solids?

Lifestyle & Movement

        

Question 12 of 22

What does your current movement during the day look like?

(e.g., do you have a sedentary job, take daily walks, perform structured exercise like cardio or strength training, etc.)

Current Eating

     

Question 14 of 22

How many times do you eat per day?

Question 15 of 22

Describe your typical Breakfast

Question 16 of 22

Describe your typical Lunch

Question 17 of 22

Describe your typical Dinner

Question 18 of 22

Describe your typical Snacks

Question 19 of 22

How many meals per week do you eat out?

A

None

B

1 to 2

C

3 to 4

D

4 or more

Question 20 of 22

If you eat out, what is the most common meal you eat out for?

Question 21 of 22

When you think about how you will monitor your food intake, which of the following seem most like something you'd want to do?

 

(Select all that apply)
A

Calorie Tracking

B

Plate Method (portion sizes)

C

Macro Tracking

D

Hunger/Fullness Cues

Question 22 of 22

Is there anything else about yourself that you would like to share to help me build the perfect postpartum weight loss plan for you?

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