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Premium/Elite Membership Monthly Evaluation Form

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.

First nameyour full name
Last nameyour full name

*NOTE: FIRST NAME, LAST NAME, AND EMAIL MUST MATCH YOUR PURCHASE ORDER.

Age
Birthdate

Height:

Weight:

Starting Weightyour full name
Current Weightyour full name
Goal Weightyour full name
Comment on rate of weight loss
Rate of Weight Loss*

*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.

*Have your ever been diagnosed with any hormonal issues?
Describe here.
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Are you pregnant or breastfeeding?
If breastfeeding, approximately how many ounces do you lactate per day?
If pregnant, how far along are you?

Date of Last Evaluation:

Purpose of Evaluation:

MACRONUTRIENT INFORMATION

Please provide your previous macronutrient breakdown below:

Calories (kcal)
Protein (g)
Carbs (g)
Fat (g)
Are you satisfied with your current calorie level? Explain below.
Explain here.
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Are you satisfied with your current macronutrient ratio? Explain below.
Explain here.
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Would you like to change your current style of macros?

If yes, please select the style of macros you'd prefer:

Other
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How consistently have you followed your recommended macronutrient ratios?
Feel free to elaborate!
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How would you describe your level of hunger while following your recommended macronutrient ratios?

PROGRESS INFORMATION

How do you feel about your overall progress?
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Have you noticed any changes in the way your clothes fit? If yes, please describe below.
Describe here.
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Have you noticed any changes in strength and/or endurance? If yes, please describe below.
Describe here.
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Have you noticed any changes in muscle definition? If yes, please describe below.
Describe here.
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Have you noticed any changes in the way your clothes fit? If yes, please describe below.
Describe here.
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Have you been taking progress pictures?

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.

Nutrition Label - Protein Supplementupload
cloud_uploadUpload


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?



Describe here.
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What did you NOT like about your previous set of menus?

Describe here.more details
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What would you like to see on your next set of menus?

Describe here.more details
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What would like to see repeated on your next set of menus?

Describe here.more details
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Would you like your menus to be similar to what you typically eat?

List 5 or more of your favorite protein sources below (e.g. fish, chicken breast, tofu, beans).

List 5 or more of your favorite protein sources here.more details
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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 fat sources here.more details
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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 starchy carb sources here.more details
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List 5 or more of your favorite vegetables below.

List 5 or more of your favorite vegetables here.more details
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List 5 or more of your favorite fruits below. 

List 5 or more of your favorite fruits here.more details
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Are you using a new protein supplement?

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.

Nutrition Label - Protein Supplementupload
cloud_uploadUpload
Are you using any other new supplements (i.e. BCAAs, protein bars, pre-workout, benefiber, etc)?

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.

Nutrition Label - Other Supplementsupload
cloud_uploadUpload
How many meals can you reasonably fit into your day?
Comment on the number of meals you can reasonably fit into your daymore details
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Do you want a meal plan based on convenience or variety?
Activity Factor
Has your overall activity level changed since your last evaluation? If yes, please describe below.
Describe here.
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How many days a week are you planning on working out?
Select which best describes your level of activity outside of working out:
What time of day do you workout?
Do you want home or gym workouts? (choose one)
What best describes your eating style? Check all that apply:
Check any ALLERGIES you have:
Other Allergies:
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Do you mind eating the same protein and vegetables at both lunch and dinner?
Would you like any of your menus to contain the same meal for both lunch and dinner?

Menus/Food Style

*Please note we may not be able to honor every request.

Breakfast:I like these types of breakfasts.
Other things you like for breakfast not listed
Lunch:I like these types of lunches.
Other things you like for lunch not listed
Dinner:I like these types of dinners.
Other things you like for dinner not listed

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:

Protein for my meal plan
Yes**No*
Ahi Tuna
Bacon
Beef Jerky
Beyond Meat Products
Bison
Black Bean Spaghetti Pasta
Built Bars
Cod
Chicken
Chickpea Pasta
Chicken Sausage
Collagen Peptides
Cottage Cheese
Dairy
Deli Style Meat
Edamame
Edamame Pasta
Egg White Protein Powder
Egg Whites
Eggs
Eggs are part of a recipe (i.e. pancakes)
Epic Bars
Greek Yogurt
Hemp Protein
Lamb
Lamb Chop
Mahi Mahi
Meat Alternatives
Micellar Casein
Milk Protein
Mung Bean Pasta
Mung Bean Sprouts
PB2 Powder
Pea Protein
Pepperoni
Pork (in general)
Pork Sausage
Pork Tenderloin
Protein Bars
Protein Pancakes (homemade)
Protein Shakes
Prosciutto
Quest Bars
Red Meat (Beef)
Rice Protein
Rx Bars
Salami
Salmon
Scallops
Seitan
Sea Bass
Shrimp
Smoked Salmon
Smoothies
Soy
Soy Protein
Spirulina Powder
Tofu
Tempeh
Tilapia
Tuna
Turkey
Turkey Bacon
Turkey Jerky
Turkey Sausage
Whey Protein
Yogurt (regular)
Yogurt (almond milk)
Yogurt (coconut milk)

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


*Fats for my Meal Plan:

Fats for my meal plan
Yes**No*
Almond Butter
Almonds
Almond Milk
Avocado
Avocado Oil
Butter
Blue Cheese
Brazil Nuts
Cacao Nibs
Cashews
Cashew Butter
Cashew Milk
Cheddar Cheese
Cheese (regular)
Cheese (vegan)
Chia Seeds
Coconut Manna (Butter)
Coconut Milk
Coconut Oil
Cream Cheese
Feta Cheese
Flax Seeds
Ghee
Goat Cheese
Gorgonzola Cheese
Half and Half
Heavy Cream
Hemp Seeds
Hummus
Macadamia Nuts
Mayonnaise
MCT Oil
Milk, 1%
Milk, 2%
Milk, Skim
Milk, Whole
Mozzarella Cheese
Oat Milk
Olive Oil
Olives
Parmesan
PB2 Powder
Peanut Butter
Peanuts
Pecans
Pesto Sauce
Pine Nuts
Pistachios
Pumpkin Seeds
Provolone Cheese
Sesame Oil
Sesame Seeds
Shredded Coconut
Sour Cream
Soy Milk
String Cheese
Sunflower Seeds
Sunflower Oil
Tallow
Vegetable Oil
Walnuts

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


*(Carbs) Starches for my Meal Plan:

Carbs/Starches for my Meal Plan:
Yes**No*
Acorn Squash
Almond Flour
Almond Flour Tortillas
Apple Sauce (Unsweetened)
Beets
Black Beans
Brown Rice
Butternut Squash
Cannellini Beans
Chickpeas (Garbanzo Beans)
Cinnamon
Cocoa Powder
Coconut Aminos
Coconut Flour
Corn
Corn Tortillas
Couscous
English Muffins
Ezekiel Bread
Garlic
Gluten Free Bread
Gluten Free Oatmeal
Gluten Free Pasta
Granola
Honey
Hot Sauce
Instant Oatmeal
Keto-Friendly Bread
Kidney Beans
Lentils
Marinara Sauce
Matcha Powder
Oatmeal Flour
Oats
Panko Crumbs
Pinto Beans
Pitas
Polenta
Popcorn
Protein Pancake Mix (Kodiak Cakes)
Pumpkin Puree
Quinoa
Quinoa Bread
Red Lentil Pasta
Red Potatoes
Rice Cakes
Rx Bars
Siete Tortillas (Almond Flour Tortillas)
Soy Sauce
Spaghetti Squash
Sriracha
Steel Cut Oats
Sweet Potato Chips
Sweet Potato Fries
Sweet Potatoes
Tomato Sauce
Wheat Flour Tortillas
White Bread
White Rice
Whole Wheat Bagel
Whole Wheat Bread
Whole Wheat Pasta
Wild Rice

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


*(Carbs) Veggies + Fruits for my Meal Plan:

Carb (veggies) for my plan
Yes**No*
Apples
Artichokes
Arugula
Asparagus
Banana
Banana Chips
Basil
Bell Peppers
Blackberries
Blueberries
Bok Choy
Broccoli
Brussels Sprouts
Cabbage
Cantaloupe
Capers
Carrots
Cauliflower
Celery
Cilantro
Collard Green Leaves
Craisins
Cucumber
Dates
Eggplant
Grapefruit
Grapes
Honeydew
Iceberg Lettuce
Jalapeno Peppers
Kale
Mango
Mixed Berries
Mushrooms
Onions
Oranges
Peaches
Pears
Peas
Pineapple
Plantains
Pomegranate Seeds
Radishes
Raisins
Raspberries
Romaine Lettuce
Salsa
Snow Peas
Spinach
Strawberries
String Beans
Sun-Dried Tomatoes
Tomatoes
Turnips
Watermelon
Zucchini

What do you want in your 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:

Seasonings and Condiments in my plan
Yes**No*
Apple Cider Vinegar
Balsamic Vinegar
Lemon Juice
Lime Juice
Liquid Aminos
Old Bay Seasoning
Stevia
Body Type
Commentsmore details
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What is the best phone number to reach you at?
If you chose "other," please provide that method of contact here
ACKNOWLEDGEMENT: Yes, I have reviewed my answers and understand that the program CANNOT be re-adjusted to accommodate for changes after hitting "SUBMIT."
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