Meal Prep Consultation Questionnaire

Full Name*

First NameLast Name
MaleFemale
Date of Birth*

MonthDayYear
Height
cm
Weight
Lbs
How did you hear about Next Level Meals?
(A friend, family member, Facebook, IG)
Minimal activity (desk job, couch potato, no motivation)Moderate (light activity such as walking, somewhat)High (heavy labor, very active, always on the go)
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?
Improved healthImproved enduranceIncreased strengthIncreased muscle massFat loss (Body Fat)Improved MoodSense of controlBoosting cofidenceMore Mental FocusExercise, meal coaching, and resultsHerbalife Nutrition Program
YesNo
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?)
low-fatlow-carbhigh-proteinVegetarian/VeganNo special diet
low-fatlow-carbhigh-proteinVegetarian/VeganKetoNo special diet, I’m not pickyOther
ChickenGround TurkeyBeefSteakVegan
What protein sources will you not indulge in?
Brown RiceQuinoa (Google it, if you don’t know what it is)Sweet PotatoCouscous (Google it, if you don’t know what it is)Jasmine RiceBasmati RiceTortilla wrap - CornTortilla wrap - WheatBlack BeansRoasted Potatoes
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?
MustardGreek YogurtVinegarExtra Virgin Olive OilCoconut OilAvocado OilSriracha/Hot SauceCholulaSour CreamBalsamic VinaigretteRanchMayoBlue CheeseOther
Natural (no seasoning)Seasoned (No additional sodium)Seaoned (Healthier sodium alternative, like Pink Salt, Sea Salt)Salted (regular salt)
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 🤍

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