Nutrition & Meal Plan Intake Form

First name

Last name

Birthday

Month

Day

Year

Email

Phone

Height

Current Weight

Target Weight

Target timeline for achieving your goal: _______

Gender

Male

Female

Other

What is your primary health/fitness goal?

Weight Loss

Muscle Gain

Maintenance

Other

Are there any foods you dislike or prefer not to include in your meal plan?

Dislikes or Preferences

What does a typical day of eating look like for you? (Include meal timings and types of food): Breakfast: _______ Lunch: _______ Dinner: _______ Snacks: _______

Do you cook at home or eat out more often?

Mostly cook at home

Mostly eat out

A mix of both

What’s your cooking skill level?

Beginner

Intermediate

Advanced

How many days per week do you exercise? _______

What types of exercise do you do?

Weight training

Cardio

Yoga/Pilates

Other

How many meals and snacks do you prefer daily? Meals: _______ Snacks: _______

Do you have any medical conditions or medications that may impact your nutrition?

None

Yes (Specify): _______

Are you currently or have you used any weight loss medication, supplements or therapies?

None

Yes (Specify): _______

Have you had any weight loss surgeries?

None

Yes (Specify): _______

Do you have any digestion issues (e.g., bloating, acid reflux)?

None

Yes (Specify): _______

Date you would like to start

Is there anything else you'd like to share about your goals, habits, or preferences?

Please submit current physique photos. Four Profiles: Front, Back, Left & Right. *Men- In Shorts or Trunks (all 4 profiles) *Women- In Bikini or Bra and underwear (all 4 profiles) *Please take photos in “good” lighting.

Fixed price

$75

Check this box if you agree to receive nutritional guidance. All meal plans are non-refundable.

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intake Forms

Nutrition & Meal Plan Intake Form