Meal Plan Questionnaire

  • Meal Plan Questionnaire

    This detailed questionnaire covers your personal information, goals, medical history, lifestyle, symptoms, anthropometry, dietary patterns, food preferences, frequency of intake, flexibility, and any other information needed to create a personalized meal plan. Once your payment is received, your plan will be reviewed and prepared within 3-4 business days.

  • Personal Information

  • Date of Birth*
     - -

  • Goals

  • Challenges to healthy eating*

  • Medical Information

  • Lifestyle

  • Work Environment*
  • Exercise Type

  • Clinical Signs/ Symptoms

  • Other Clinical Symptoms*

  • Anthropometry

  • Dietary Information

  • Cooking Methods*
  • Cooking Appliances*

  • Food Product Choices

  • Dairy Choices*
  • Meat & Protein Choices*
  • Fats, Oils & Spreads*
  • Carbohydrate Preferences*
  • Sauces & Extras*

  • Food Frequency

    For each food or drink item, select how often you consume it: daily, weekly, monthly or never.
  • For each food or drink item, select how often you consume it: daily, weekly, monthly or never.

  • Flexibility & Preferences

  • Thank you for completing the questionnaire!

    Once your payment is received, I'll carefully review your information and create a personalized meal plan tailored to your needs. You can expect to receive your plan within 3-4 business days. I'm excited to help you on your journey to better health!
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