Custom Meal Plan Form

Custom 4-Week Meal Plan

IN 2 WEEKS OR LESS!

_____________________

Please fill out the form below and you will receive your 4 Week Custom Meal Plan in 2 weeks or less.

Custom 4-Week Meal Plan Form

Please fill out the form below to the best of your ability and Alex will get
started creating your custom 4 week meal plan.

Name

Age

Height

Weight (in lbs.)

Are you a past client of ours? If yes, which programs have you completed so far?

On a scale of 1 (worst ever) to 10 (best ever), how would you rate your current level of fitness?

What does your current fitness routine look like?

Just cardio training

Just weight training

Cardio and weight training

Not currently active

If you are currently active, what does your weekly routine look like in more detail? Example: 3 days total of cardio (20 mins) and weights (30 mins) If you plan on increasing your activity once starting this meal plan, please state what your new routine will look like (note: it's important to be realistic when setting short term goals!). If it will stay the same, please state so in your response.

On a scale of 1 (poor) to 10 (excellent) how would you rate your current eating habits?

On a scale of 1 (low) to 10 (high) how would you rate your stress level?

What do you find you struggle with most when it comes to your nutrition?

What goals below apply to you?

Lose body fat

Increase lean muscle

General health

List any allergies you have or if you are vegan, vegetarian or pescatarian:

List your favourite healthy foods:

List your favourite unhealthy foods:

List any foods you really dislike:

Please provide a 1-2 day food journal. If weekdays and weekends are different record one of each. Include quantities (ex. 2 cups cherries + 1 cup skim milk) and what time you ate each meal and snack:

Custom 4-Week Meal Plan

IN 2 WEEKS OR LESS!

Custom 4-Week Meal Plan Form

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