Meal Prep Consultation Questionnaire

Full Name

First NameLast Name

Gender

Date of Birth

MonthDayYear

Height

cm

Weight

Lbs

How did you hear about Next Level Meals?

(A friend, family member, Facebook, IG)

What is your daily activity level?

Do you follow a regular working schedule? Do you work days, afternoon or nights?

Do you have any medical problems or allergies?

(Such as diabetes, food allergies, etc.)

If you are on any medications, please list them.

What additional therapies are being undertaken for the given health problem(s)?

I.e., IV therapy, Dialysis, etc.

Do you have any injuries, or recent surgeries?

(Broken bones, stitches)

What additional therapies are being undertaken for the given injury?

I.e., Physical therapy, Occupational therapy, etc.

What are your long term goals?

(Looking for a better lifestyle, weight loss, better eating habits)

How much weight would you like to lose, or how much healthy weight would you like to gain?

What following goals speak to you the most?

Are you experiencing any stresses or motivational problems?

If yes, please explain:

(Need to join a group of motivational influences, accountability, coaching, etc.)

If yes, what do you feel can assist you with achieving your goals?

(How can I help you, on learning, how to do this entire Herbalife Program?)

Your current diet could be best characterized as:

Your ideal diet would be best characterized as:

What sources of protein do you enjoy?

What protein sources will you not indulge in?

What sources of carbohydrate do you enjoy?

What carbohydrate sources will you not indulge in?

What vegetables do you enjoy the most?

What vegetables do you not enjoy?

What is your favorite food?

What is your least favorite food?

Please select the condiments that you enjoy:

How would you like your meals seasoned?

How many meals a DAY are you looking to have prepared for you?

One a day, Two meals a day , Three, etc.

How many DAYS of a meal prep would you like prepared for you?

I.e., One day, Three days, Five days, Seven days, etc.

Thank you for your information!
Once received, we will have a BETTER understanding in the type of program you are looking for!

Please review the programs Food Menu, let your coach know what meals you would like to chose 🤍

Please have all orders paid to:

CASH APP: $LizGarfias