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- How many meals per week do you need?*
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Format: (000) 000-0000.
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- Local Delivery ZIP Eligibility*
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- Are you applying for:*
- PRIMARY Ethnicity of applicant?*
- Gender of applicant*
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- Which of the following are you currently experiencing? (select all that apply)*
- Have you been diagnosed by a medical professional?*
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- (For Cardiac Support Applicants ONLY) Do you have at least 3 of the following? High blood pressure, Diabetes, Obesity, History of Heart Disease, BMI >27?
- (For Oncology Support Applicants ONLY) Select All that apply
- (For Renal Support Applicants ONLY) Select All that apply
- (For Eating Disorder Recovery Applicants ONLY) Select All that apply
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- Do you have any food allergies or religious preferences? Select all that apply*
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- Delivery Area*
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- I understand that meals are customized using my written intake, medical guidance, allergies, restrictions, tolerances, and reasonable preferences, and that BNDK Purposeful Plates retains control over menu design, ingredients, approved proteins, availability, food safety, cost limitations, and production capabilities. I agree to consume at least 80% of the meals provided. I acknowledge that I must begin within 30 days of approval, submit changes at least seven days before production, follow delivery and food-safety policies, and not transfer meals without written approval. I understand that one pause of up to 14 days may be requested for hospitalization, treatment changes, or another approved circumstance, and that after 30 days without communication, participation may be closed and unused donor-supported meals returned to the program.*
- Do you agree to consume at least 80% of meals?*
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- Which best describes your current situation?*
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- How ready are you to make nutrition and lifestyle changes that support your health?*
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- What do you believe is the root cause for every metabolic disease known to man?*
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- How would you rate your current energy levels?*
- Which areas are you currently struggling with most? (Select up to 3)*
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- Do you need financial assistance with the $300 participant contribution?*
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- Before submitting, please confirm:
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- Acknowledgment of Risk & Liability Waiver for the Terms mentioned above*
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- How should your identity appear publicly?
- May we use your photograph in the campaign?
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- Where are you willing to share your campaign?
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- Should be Empty: