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Meal Plan Questionnaire
Fill out the questionnaire below please
Height (in cm)
Weight (in kg)
What is your goal for following a meal plan?
Loose weight (Less than 5kg)
Loose weight (more than 5kg)
Get more energy
Get awareness of my diet
How much time do you spend sitting down in a day?
Less than 1h
More than 6h
How much time do you spend on sports and fitness in a day?
I don't exercise
1h or less
More than 3h
How many hours do you sleep each night?
Less than 5h
More than 8h
Are you a vegetarian?
Do you have any allergies?
If Yes, what allergies do you have?
Do you have any illness that I must be aware of?
Is there any foods you don't like to eat?
Is there any foods you just can't be without?
How many times do you usually eat per day?
5 or more times per day
Do think you eat more than you should?
Do you think you eat less than you should?
Do you know approximately calories you consume on a average per day?
How often do you drink alcohol?
less than 1 time/week
More than 3 times/ week
Do you smoke?
How often do you eat out?
Never or very rarely
Often or every day
Have you been on a meal plan before?
If yes, what was your experience of it?
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 this is a one-off non- refundable monthly payment.
No, l disagree
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