Meal Plan Questionnaire

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MEAL PLAN

Full Name

Email

Company

Are you a dependent of an employee?

YES NO

If Yes, Employee Name

What is your age

What is your height

What is your weight

What is your Sex

What is your fatigue on a day to day basis?

Extremely Energetic Energetic Normal Energy A Little Flat and Tired Very Flat and Tired

How many meals are you looking to plan for?

1 2 3 4 5 6 7 8 9 10 11 12 13 14

How often can you meal prep each week?

What type of meal plan are you looking for?

What days of the week and meals do you want to meal prep for?

Sunday Meals

Monday Meals

Tuesday Meals

Wednesday Meals

Thursday Meals

Friday Meals

Saturday Meals

Please list any food allergies

Please list any food intolerances

List any foods you strongly dislike/will not eat

List any foods you would like included more of in your diet:

Do you enjoy cooking/know how to?

Do you plan to work out?

What is your biggest challenge with meals?

How stressed are you when it comes to food and cooking?

1 - Ain't No Thing but a Chicken Wing 2 - A Lil Bit 3 - All of This Makes Me Anxious 4 - VERY Stressed

What do you have access to cook with?

Anything else we should know?

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The APEX – Wellness & Culture Center
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