Fitness & Health Survey
How would you describe your energy levels?
Up & down
Lethargic
Ok
Excellent
Would you like to improve your energy levels?
Please Select
Yes
No
Do you exercise?
Not at All
1-2 days a week
3-4 days a week
5-6 days a week
Everyday
Occasionally
What exercises do you do? (Select all that apply.)
Walking
Running
Weight Lifting
Swiming
Golf
Team Sports
Cycling
Boxing
Strength Training
Yoga
Other
Would you like to?
Gain weight
Lose weight
Reshape your body
Trim body fat
Other
How much would you like to lose/gain to achieve your ideal weight?
Less than 5 lbs
5-10 lbs
10-20 lbs
20-30 lbs
30+ lbs
Other
Do you feel that you receive a balanced nutrition daily, from the foods you eat?
Please Select
Yes
No
Sometimes
What is your preferred diet type?
Paleo diet
Keto diet
Vegan diet
Mediterranean diet
Vegetarian diet
Pescatarian diet (seafood + vegetarian diet)
See food you eat it diet (I eat all food types)
Other
Do you fast or practice intermittent fasting?
Please Select
Yes
No
Sometimes
How many times a day do you prefer to eat?
1
2
3
4
5
6 or more
What is your preferred protein source? (Select all that apply.)
Beef
Chicken
Turkey
Pork
Seafood
Vegetarian
Vegan
Other
Do you have any food allergies?
Do you have any hereditary illnesses?
This is to better serve you and avoid foods in your plan that could react to certain hereditary illnesses.
Do you currently count your daily calories?
Please Select
Yes
No
Sometimes
How much time would it save you per day if we calculated all of your calorie & nutrition needs according to your goals?
No time
1 hour
2 hours
3 hours
3+ hours
How much time would it save you per day if we delivered all of your gourmet meals to your door weekly and you would never have to go to the grocery store for food, pick up food, cook food or clean up from cooking?
No time
1 hour
2 hours
3 hours
3+ hours
Based on your 2 previous answers, how much time total per day would you save with our gourmet meal prep delivery service?
No time
1-2 hours
2-3 hours
3-4 hours
4+ hours
How much time is this saved per week? (Multiply daily hours saved by 7.)
No time
Up to 7 hours weekly
Up to 14 hours weekly
Up to 21 hours weekly
Up to 28 hours weekly
Over 28 hours weekly
Would saving this amount of time every week be helpful for you to build your business, work more hours or spend more time with family?
Please Select
Definitely!
Not really
What would your life look like with this amount of extra time weekly?
Is having a flavorful variety of foods important to your diet?
No, I don't care much about taste.
Yes, I want my food to taste good!
Would it help you stay consistent with your diet if all of your meals for your meal plan were prepared by award-winning chefs?
Yes!
Not really.
If our gourmet meal prep delivery service would significantly save you time, ensure you make significant progress towards your health goals, help improve your energy levels all while eating delicious meals prepared by our partnered award-winning chefs that are delivered directly to your door every week, would you be interested in a free wellness consultation?
Please Select
Absolutely!
No
If your answer is yes, which type of gourmet meal plan would you be interested in?
Single (Weekly meals for 1 person)
Couples (Weekly meals for 2 people)
Family (Weekly meals for 3 or more)
1 Week Trial (Does Not Include Supplements)
Since all of our meals are fresh, never frozen and prepared with high quality ingredients, all weekly meal deliveries would need to be eaten within 1 week, is this okay?
Please Select
Yes
No
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
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*
*After you submit your form, this page will direct you to select a time to schedule a free wellness consultation.
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