THE WELLNESS NUTRITION CO. PERSONALISED MEAL PLAN QUESTIONNAIRE
Name
*
First Name
Last Name
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Height
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Weight
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CALORIES & MACROS
Have your calories and macros been calculated by The Wellness Nutrition Co?
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Yes
No
If YES, please list your current targets:Calories:⸻Protein:⸻Carbohydrates:⸻Fats:⸻Fibre:
If NO, please list the calories/macros you would like your meal plan based around:Calories:⸻Protein:⸻Carbohydrates:⸻Fats:⸻Fibre:⸻
IMPORTANT DISCLAIMER
If your calories and macros have NOT been calculated by The Wellness Nutrition Co, your meal plan will be created using the information and targets you provide.While every effort will be made to get meals and nutrition as close as possible to your supplied calories and macros, exact figures cannot be guaranteed.The Wellness Nutrition Co does not guarantee weight loss, body composition changes, or specific health outcomes from meal plans created using externally supplied calorie or macro targets.By proceeding, you acknowledge that The Wellness Nutrition Co accepts no liability or responsibility for outcomes related to incorrect, unsuitable, or self-calculated calorie and macro targets supplied by the client.
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I understand and agree to the above disclaimer.
DIETARY INFORMATION
Do you follow any specific dietary style?(Select all that apply)
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Vegetarian
Vegan
Pescatarian
Gluten free
Dairy free
Low Carb
High Protein
Family Friendly
None
Other
Please list ALL allergies, intolerances, sensitivities, or foods that must be avoided:
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Please list ALL foods you dislike or refuse to eat:
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Please list foods/meals/snacks you enjoy and would like included:
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How many people are dinners for?
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1
2
3
4+
What style of meals do you prefer?(Select all that apply)
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Meal Prep Friendly
Freezer Friendly
Budget Friendly
Under 15 minutes
Under 30 minutes
Family Friendly
Minimal Cooking
Air fryer Friendly
Slow cooker meals
Simple meals
Other
Lunch Preference:
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Meal Prep Lunches
Dinner Leftovers
Different daily
Dinner Preference:
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Different Daily
Dinners with leftovers
Quick & Easy
Snack Preference:
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Sweet
Savoury
High Protein
Low Prep
What cooking equipment do you currently have access to?(Select all that apply)
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Oven
Stove
Microwave
Airfryer
Slowcooker
pressure cookers
Sandwich press
Blender
Food processor
BBQ
Limited cooking materials
Approximate weekly food budget:
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Under $80
$80-$120
$180+
How confident are you in the kitchen?
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Beginner
Moderate
Confident
Do you need meals suitable for children or fussy eaters?
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Yes
No
If yes, please explain
Is there anything else you’d like me to know to help create your meal plan?
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Client Agreement
By submitting this form, I understand:
• This meal plan is for educational purposes only.This meal plan remains the property of Wellness Nutrition Co. and must NOT be duplicated or given to others • Individual results will vary.• Weight loss or health outcomes cannot be guaranteed.• The Wellness Nutrition Co is not liable for outcomes related to inaccurate information supplied by the client.• Meal plans are personalised based on the information provided in this questionnaire.
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I confirm all information provided is accurate to the best of my knowledge.
Signature
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Date
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-
Month
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Day
Year
Date
Continue
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