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Meal Plan Questionnaire
Fill out the questionnaire below please
Name *
Your answer
Mail address *
Your answer
Age *
Your answer
Height (in cm) *
Your answer
Weight (in kg) *
Your answer
Gender *
What is your goal for following a meal plan?
How much time do you spend sitting down in a day?
How much time do you spend on sports and fitness in a day?
How many hours do you sleep each night?
Are you a vegetarian?
Do you have any allergies?
If Yes, what allergies do you have?
Your answer
Do you have any illness that I must be aware of?
Your answer
Is there any foods you don't like to eat?
Your answer
Is there any foods you just can't be without?
Your answer
How many times do you usually eat per day?
Do think you eat more than you should?
Do you think you eat less than you should?
How often do you drink alcohol?
Do you smoke?
How often do you eat out?
Have you been on a meal plan before?
If yes, what was your experience of it?
Your answer
WAIVER, RELEASE OF LIABILITY AND AGREEMENT. In consideration for the services rendered by SUPERSET of a nutrition program for my benefit, I agree to waive any rights, claims or damages for injuries that may occur as a result of me following a nutrition program. I agree to disclose any physical limitations, disabilities, ailments or impairments that may affect my ability to follow a meal plan. I understand that SUPERSET is a personal training business and not a medical doctor, and that it will, in fact, be relying on my representations and disclosures regarding my health and physical condition. I also do not hold SUPERSET or its employees for any personal injuries, bodily injuries while undertaking the nutrition program. I understand that l can not bring young children to participate in any of SUPERSETS nutrition programs. I understand this is a non- refundable monthly payment. *
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