You can always press Enter⏎ to continue
Get A Free Nutritionist Designed Meal Plan
Complete this form in its entirety and a Well-Choices Nutritionist will email you a custom designed meal plan within 48 hrs.
36
Questions
START
1
Name
*
This field is required.
First Name
Last Name
Previous
Next
Submit
Press
Enter
2
Would you like a meal plan filled with interesting recipes or a simple easy to follow outline?
*
This field is required.
Rotating Plan with Fun & Interesting Recipes
Rotating Plan with Quick & Simple Recipes
Rotating Plan with a Mixture of Quick Recipes & More Complex Recipes
Simple Outline with Portions & Ingredient Substitutions
Previous
Next
Submit
Press
Enter
3
How many unique recipes would you like each week
1 = 1 unique recipe per week per meal that repeats each day. 7 = 7 unique recipes per week per meal, no repeats
Breakfast
Morning Snack
Lunch
Midday Snack
Dinner
Night Snack
1
2
3
4
5
6
7
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 0, Column 5
Row 0, Column 6
1
2
3
4
5
6
7
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 1, Column 5
Row 1, Column 6
1
2
3
4
5
6
7
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 2, Column 5
Row 2, Column 6
1
2
3
4
5
6
7
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 3, Column 5
Row 3, Column 6
1
2
3
4
5
6
7
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Row 4, Column 5
Row 4, Column 6
1
2
3
4
5
6
7
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Row 5, Column 5
Row 5, Column 6
Breakfast
Morning Snack
Lunch
Midday Snack
Dinner
Night Snack
1
2
3
4
5
6
7
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 0, Column 5
Row 0, Column 6
1
2
3
4
5
6
7
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 1, Column 5
Row 1, Column 6
1
2
3
4
5
6
7
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 2, Column 5
Row 2, Column 6
1
2
3
4
5
6
7
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 3, Column 5
Row 3, Column 6
1
2
3
4
5
6
7
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Row 4, Column 5
Row 4, Column 6
1
2
3
4
5
6
7
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Row 5, Column 5
Row 5, Column 6
Previous
Next
Submit
Press
Enter
4
Do you prefer to make your own snacks or purchase store made snacks?
*
This field is required.
Select all that apply
Make my own healthy snacks
Purchase premade snacks
Simple snack ideas
Previous
Next
Submit
Press
Enter
5
Do you like integrating protein shakes into your meal plan?
*
This field is required.
Always
Sometimes
Never
Previous
Next
Submit
Press
Enter
6
Do you request or require a specific diet type?
*
This field is required.
Well-Choices promotes eating a healthy, well-balanced diet to avoid nutrient deficiencies. Well-Choices will create meal plans based on the client's dietary needs or requests but does not endorse any specific diet type.
I Prefer a Balanced Diet
low-FODMAP
Mediterranean
Pescatarian
Vegan
Vegetarian
Other
Previous
Next
Submit
Press
Enter
7
You selected "Other" as your requested or required diet type.
Please explain the diet type you would like to follow
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
8
Do you have any of these common food allergies?
Dairy
Egg
Fish
Gluten
Peanuts
Shellfish
Soy
Tree nuts
Other
Previous
Next
Submit
Press
Enter
9
List all of your food allergies
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
10
How would you like to identify the ingredients or foods you want to be EXCLUDED from your meal plan?
*
This field is required.
Simple
Advanced
Previous
Next
Submit
Press
Enter
11
List all ingredients or foods you want EXCLUDED from your meal plan
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
12
Fruit: Select all ingredients that need to be EXCLUDED from your plan.
Apple
Apricots
Avocado
Banana
Blackberries
Blueberries
Cantaloupe
Cherries
Cranberries
Dates
Grapefruit
Grapes
Honeydew melon
Kiwi
Lemon
Lime
Mango
Melon
Orange
Papaya
Passion fruit
Peaches
Pear
Pineapple
Plantain
Plum
Pomegranates
Prunes
Raisin
Raspberries
Red currants
Strawberries
Tangerines
Watermelon
Previous
Next
Submit
Press
Enter
13
Vegetables: Select all ingredients that need to be EXCLUDED from your plan.
Acorn squash
Artichoke
Asparagus
Beets
Bell pepper
Broccoli
Brussel sprout
Butternut squash
Cabbage
Carrots
Cauliflower
Celery
Chili peppers
Chives
Collard Greens
Corn
Cucumber
Eggplant
Garlic
Ginger
Green beans
Green onions
Green peas
Greens
Kale
Kohlrabi
Leeks
Lettuce
Mushroom
Mustard greens
Olives
Onion
Parsnips
Pickles
Portobello mushroom
Potato
Pumpkin
Radish
Red cabbage
Red onion
Rhubarb
Romaine lettuce
Rutabagas
Sauerkraut
Scallions
Shallots
Shiitake mushrooms
Snow peas
Spaghetti squash
Spinach
Squash
String Beans
Sugar snap peas
Summer squash
Sun-dried tomatoes
Sweet peas
Sweet Potato
Tomato
Turnip greens
Turnips
Watercress
White button mushrooms
Winter squash
Yams
Yellow Squash
Zucchini
Previous
Next
Submit
Press
Enter
14
Grains: Select all ingredients that need to be EXCLUDED from your plan.
Barley
Brown rice
Buckwheat
Grains
Noodles
Oatmeal
Pancakes
Rye
Wheat bran
Wheat germ
Quinoa
White bread
Whole wheat bread
Wrap
Previous
Next
Submit
Press
Enter
15
Meat-Based Protein: Select all ingredients that need to be EXCLUDED from your plan.
Bacon
Beef
Bison
Chicken
Egg
Ham
Lamb
Pepperoni
Pork
Roast beef
Sausage
Steak
Turkey
Turkey Bacon
Veal
Previous
Next
Submit
Press
Enter
16
Vegetable-Based Protein: Select all ingredients that need to be EXCLUDED from your plan.
Black Beans
Edamame
Falafel
Garbanzo beans
Kidney beans
Lentils
Lima beans
Navy beans
Red beans
Soy
Tofu
White beans
Previous
Next
Submit
Press
Enter
17
Shellfish: Select all ingredients that need to be EXCLUDED from your plan.
Calamari
Clams
Crab
Eel
Lobster
Mussels
Octopus
Oysters
Scallops
Shrimp
Snail
Previous
Next
Submit
Press
Enter
18
Fish: Select all ingredients that need to be EXCLUDED from your plan.
Catfish
Cod
Flounder
Halibut
Herring
Pollock
Salmon
Sardines
Sea Bass
Swai
Tilapia
Trout
Tuna Fish
Swordfish
Previous
Next
Submit
Press
Enter
19
Seeds/+: Select all ingredients that need to be EXCLUDED from your plan.
Chia Seed
Chocolate
Coconut
Flax Seed
Pesto
Pumpkin seeds
Sesame seeds
Sunflower seeds
Previous
Next
Submit
Press
Enter
20
Tree Nuts: Select all ingredients that need to be EXCLUDED from your plan.
Almonds
Brazil nuts
Cashews
Chestnuts
Hazelnuts
Hickory nuts
Macadamia nuts
Pecans
Pine nuts
Pistachios
Walnuts
Previous
Next
Submit
Press
Enter
21
Dairy: Select all ingredients that need to be EXCLUDED from your plan.
Cheese
Cottage cheese
Greek yogurt
Milk
Yogurt
Previous
Next
Submit
Press
Enter
22
Seasonings/+: Select all ingredients that need to be EXCLUDED from your plan.
Basil
Bbq sauce
Cilantro
Cinnamon
Clove
Coffee
Curry
Dill
Fennel
Guacamole
Honey
Hummus
Jalapeno
Ketchup
Liquid Aminos
Mayo
Mustard
Nutritional Yeast
Oregano
Paprika
Parsley
Pepper
Peppermint
Pumpkin spice
Rosemary
Sage
Salt
Seaweed
Soy sauce
Sugar
Sweet Chili sauce
Tahini
Thyme
Turmeric
Vanilla
Vinegar
Wasabi
Previous
Next
Submit
Press
Enter
23
Health Goals
*
This field is required.
What are you trying to accomplish by modifying your nutrition?
Athletic Performance
Gain Muscle
Increase Energy
Healthy Lifestyle Change
Weight Loss
Other
Previous
Next
Submit
Press
Enter
24
How much weight do you want to lose?
In lbs.
Previous
Next
Submit
Press
Enter
25
How much muscle do you want to gain?
In lbs.
Previous
Next
Submit
Press
Enter
26
You selected "Other" as your Health Goal.
Please explain your health goals.
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
27
Current Age
*
This field is required.
Previous
Next
Submit
Press
Enter
28
Do you have any health conditions or other dietary restrictions?
Please list any health conditions or dietary restrictions, including any medications you are currently taking.
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
29
Gender
*
This field is required.
Previous
Next
Submit
Press
Enter
30
Height
*
This field is required.
Feet & Inches
Previous
Next
Submit
Press
Enter
31
Current Weight
*
This field is required.
In Lbs.
Previous
Next
Submit
Press
Enter
32
Exercise & Activity
*
This field is required.
Please take a moment to tell us how often you exercise, and your current level of activity.
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
33
Are there any other notes or requests you would like to add?
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
34
Email
*
This field is required.
Where should we send the meal plan?
example@example.com
Previous
Next
Submit
Press
Enter
35
Phone Number
*
This field is required.
A Nutritionist may need to contact you with questions regarding your meal plan.
Please enter a valid phone number.
Previous
Next
Submit
Press
Enter
36
Disclaimer
*
This field is required.
Well-Choices provides nutrition and wellness advice and gives advice concerning proper nutrition – which is the giving of advice as to the role of food and food ingredients, including supplements. All nutritional advice is intended for informational purposes only and intended for use by persons having appropriate technical knowledge, and at their own discretion and risk. Well-Choices free meal plans and free online content is not meant to diagnose, prevent, treat or cure any disease, pain, deformity, injury, or physical or mental condition. Well-Choices in no way provides any warranty, express or implied, towards content of any foods. It is the client’s responsibility to determine the value and quality of any foods. Well-Choices requires that you are acknowledging that you are participating voluntarily in using any of our e-mails, programs, services, and/or products, for educational purposes only and you alone are solely and personally responsible for your results. You acknowledge that you take full responsibility for your health, life, and well-being. Well-Choices statements, both written and verbal, have not been evaluated by the Food and Drug Administration.
I Understand
Previous
Next
Submit
Press
Enter
Should be Empty:
Question Label
1
of
36
See All
Go Back
Submit