Meal Plan Client Information Form
Thank you for signing up for my personalized meal plan. By signing up you agree to our Terms and Conditions. Please consult your doctor before starting a new wellness program. Fill out ALL the questions below so we can get to know you better. Your information will never be shared and is completely confidential. The more information you provide the better :) If you signed up for my fitness program you can answer the questions not already on the previous questionnaire. Thanks!
General
Name *
Your answer
Best number to reach you at? *
Your answer
E-mail Address
Your answer
Sex
Age
Your answer
Height
Your answer
Weight
Your answer
Body Fat % (If you know it)
Your answer
How many days a week do you workout?
Your answer
Marital Status
Do you have children?
Birthdate
Your answer
Occupation
Your answer
Does your occupation require extended periods of sitting?
Your answer
How did you hear about The Blissful Chef?
Your answer
What are your reasons for getting this personalized meal plan? *
Your answer
What do you hope to get out of following a meal plan? *
Your answer
Have you read and agreed to the Terms and Conditions? *
You must read and agree to the T & C before starting the program found here: http://theblissfulchef.com/terms-and-conditions/
Required
Medical History
Are there any health conditions that I should know about?
Your answer
Has your doctor ever diagnosed you with a chronic disease such as any of the ones listed below?
If you checked any box above, has your doctor given you written clearance to start an exercise program?
If not, please get clearance from your doctor before starting our program.
Your answer
Suffered any serious injuries or have had surgeries?
Your answer
Are you taking any medications?
If yes, please list them
Your answer
Do you have any allergies to anything?
Your answer
What is your digestion like?
Your answer
Lifestyle & Diet
How many hours of sleep do you get each night?
Your answer
What is your energy level like throughout the day?
Your answer
How many times a week do you exercise?
Your answer
Are you following a fitness program designed by you or a personal trainer?
If so be very specific about your workouts, or email me photos
Your answer
What is your diet like currently? Give me sample days.
Your answer
Do you drink coffee or other stimulants?
Your answer
What are your favorite foods?
Your answer
What are your least favorite foods?
Your answer
Do you avoid gluten, nuts, soy, sugar, or anything else?
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service