AWE That Lifestyle Questionnaire!
We offer 1200-2500 calorie counted meals. 10 prepared meals (lunch/dinner) are made fresh every week. Meal prep plans start at $200.00 (per week/Bi-weekly)(Depending on dietary needs) Tell me a little bit more about you below so we can create the BEST meal plan to reach your goals!
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Gender:
*
Female
Male
Age:
*
Height:
*
Weight:
*
Weight Goal:
*
Do you have any allergies? If any, please list below.
*
What foods don't you like? What are some foods you will NEVER eat? and why.
*
Do you have any chronic health conditions (such as , but limited to cardiovascular disease, pulmonary disorders, hypertension, diabetes, or cancer)? If yes, please explain.
*
Are you on any medication? If so, please list below.
*
How many days out of the week do you engage in intentional physical activity (ie.,home workouts, walking, yoga, going to the gym)?
*
What exercise activities do you currently take part in (i.e., running, weightlifting, group exercise, etc.)?
*
How important are the following fitness goals to you?
*
Rows
Not Important
Somewhat Important
Important
Very Important
Weight Loss
Muscle Gain
Sports Performance
Health Improvement
On a scale from 0-10, how would you rate your average level of stress?
*
What are your health and fitness goals?
*
Are you currently following any kind of diet? If so, what diet and for what reason?
*
How would you rank your daily ______ intake?
*
Rows
Low
Medium
High
Salt
Sugar
Fat
On a scale from 0-10, how effectively are you able to control your temptations for junk food?
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How many alcoholic drinks do you consume per week?
*
Do you consume caffeinated beverages, such as coffee, tea, soda, and/or energy drinks? How many per week?
*
Do your best to give an example of a typical breakfast, lunch, dinner and snack for yourself.
*
What are some barriers that could prevent you from reaching your goals?
*
What are your 3 month/short term goals?
*
What are your 1 year/ long term goals?
*
Set up your consultation.
*
My Products
*
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AWE Mazing Consultation & Meal Prep Deposit
$25.00
$
25.00
Spend 1 hour with Chef AWE~Mazing via Zoom or telephone call, to review your intake form together and explore your options for your AWE~ Mazing Meal Prep Plan.
Total
$0.00
$
0.00
Payment Methods
Credit Card
Apple Pay
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Google Pay
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LETS DO THIS!
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