Before you begin, please note that you must be 18 years old or older.
This questionnaire is ONLY for clients who have purchased customized meal plans or online coaching.
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.
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.
List up to 5 requested food items or dishes below. *For any specific brand name products, a picture of the nutrition label containing the (1) calorie, (2) protein, (3) carbohydrate, (4) fiber, and (5) fat content MUST be submitted. Your request WILL NOT be honored without this information.**Please note that our nutritionists will assess your requests to see if these requests will be a realistic fit within your allotted macro goals.***Any dish or food item listed may be modified or omitted to fit your macronutrient ratios.
NOTE: MUST BE IN JPG or PNG FORMAT (with a max file size of 8000kb each image)
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.
Paleo: A paleo eating style is gluten free, grain free, lactose free, dairy free, soy free, legume free, and artificial sweetener free. There is not added benefit of this style of eating over another unless you have these specific food intolerances or if you are seeking to minimize inflammation from processed foods.
Paleo + Gluten Free Grains: This style is similar to paleo, but includes gluten free grains like rice (white, brown, wild), gluten free oats, quinoa, corn, amaranth, buckwheat, millet, sorgum, and teff. You enjoy real whole foods but do not have any sensitivites to grains and enjoy including them in your meals.
Clean Eating: Clean eating is about eating real whole foods that are minimally processed.This style of eating typically eats 3-6 times a day with a protein and carb with each meal and about 2-3 servings of fat per day.
Diabetic: A diabetic-friendly meal plan is designed to maintain healthy blood sugar levels. This style of eating tends to minimize carbohydrates, saturated fats, and sodium levels.
Pescatarian: A pescatarian style of eating tends to be higher in omega-3 fatty acids from fish for a heart healthy nutrition approach. This excludes chicken, turkey, pork, and red meat. This style of eating includes seafood, eggs, and dairy.
Flexitarian: This emerging style of eating is for those who want to be more plant based overall, but are willing to include things like chicken and fish when needed for the convenience of hitting their protein macros. There is no defined food list, but this is for those to want to be more intentional about eating plant based food choices when they are able to.
Low Carb High Fat: This style of eating is not necessarily defined by macro ratios but tends to be high in fat, moderate in protein, and moderate to moderately low in starchy carbs.
Keto: Keto is a high fat, low carb protocol designed to support improving insulin reistance. This protocol is 70-75% fat, 20-25% protein, and 5% net carbs.
Vegetarian: A vegerarian lifestyle excludes eating meat and seafoo but allows dairy and eggs.
Vegan: A vegan lifestyle excludes eating meat, seafood, dairy, and eggs and focuses more on using soley plant based ingredients for ones nutritional needs.
Intermittent Fasting: This style of eating has prolonged periods of fasting and concentrated windows of eating. A typical IF protocol is 16:8 where one fasts for 16 hours and eats within an 8 hour period.
No Preference: No eating style is preferred over another. This client will be recommended an approprate eating 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:
*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:
Picture Submission Requirements: ONLY SUBMIT 3 PICTURES. (Preferably in a bathing suit, but If you are not comfortable being photographed in a bathing suit, a sports bra and shorts is acceptable).
Please take the images from the following angles: FRONT, SIDE and BACK:
Please review your answers for accuracy. Any dietary or training needs NOT mentioned will NOT be accounted for in your program UNLESS THEY ARE EXPRESSLY WRITTEN.
Please note: Programs are sent out within 5-7 business days (weekends, holidays not included) after your phone call.