Before you begin, please note that you must be 18 years old or older.
You should consult your physician or other health care professional before starting this or any other weight loss program to determine if it is right for your needs.This form is ONLY for premium/elite GGT Lifeline Members who have followed their most recent set of macros for AT LEAST one month.*PLEASE NOTE: Evaluation CANNOT be performed without compliance with the recommended macros.
*NOTE: FIRST NAME, LAST NAME, AND EMAIL MUST MATCH YOUR PURCHASE ORDER.
Height:
Weight:
*Please note that the nutrition team will assess whether or not this is safe for you. Calorie deficit may be adjusted to ensure a safe calorie level.
**If your goal weight is significantly LESS than your current weight, this option may not be right for you.
Date of Last Evaluation:
Purpose of Evaluation:
MACRONUTRIENT INFORMATION
Please provide your previous macronutrient breakdown below:
If yes, please select the style of macros you'd prefer:
PROGRESS INFORMATION
If YES, please ATTACH images: front, back and/or side (preferably front and back). To be in either a bikini or a sports bra and shorts.
NOTE: The 4 Week Custom Meal Plan comes with four (4) menus for you to rotate and use as you choose. One (1) menu is meant for one (1) day of meals and you can prep as many days as you wish.
What did you like about your previous set of menus?
What did you NOT like about your previous set of menus?
What would you like to see on your next set of menus?
What would like to see repeated on your next set of menus?
List 5 or more of your favorite protein sources below (e.g. fish, chicken breast, tofu, beans).
List 5 or more of your favorite fat sources below (e.g. olive oil, cheese, nuts, seeds, avocado).
List 5 or more of your favorite starchy carb sources below (e.g. brown rice, sweet potatoes, squash, bread, pasta).
List 5 or more of your favorite vegetables below.
List 5 or more of your favorite fruits below.
If YES, please take a picture of the nutrition label of your protein supplement. This should include: (1) the name of the protein supplement (2) calorie, (3) protein, (4) carbohydrate, (5) fiber, and (6) fat content.
If YES, please take a picture of the nutrition label of any supplement you use. If applicable, this should include: (1) the name of the supplement (2) calorie, (3) protein, (4) carbohydrate, (5) fiber, and (6) fat content.
Menus/Food Style
*Please note we may not be able to honor every request.
What do you want in your meal plan?
*No means you will not eat this food.
**Yes means you can eat this food and this preference is ok to use in your meal plan
*Protein for my Meal Plan:
What do you want in your meal plan?
*Fats for my Meal Plan:
*(Carbs) Starches for my Meal Plan:
*(Carbs) Veggies + Fruits for my Meal Plan:
*No means you do not want this with your food.
**Yes means you want this with your food and this preference is ok to use in your meal plan
*Seasonings/Condiments for my meal plan: