Mealplan Form – BXGFIT

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Customised Meal Plan

Name *

First

Last

Gender *

Date of birth *

MM-DD-YYYY

Email *

First

Last

Your Fitness Goals

Weight Loss
Fat Loss
Bulking
Endurance
Flexibilty
Muscular Strength
Appearance
Fitness
General Conditioning
Toning & Shaping
Posture

Do you exercise regularly?

I have never exercised regularly
I used to exercise regulary
I exercise every now and then
I currently exercise regularly

Do you have any diagnosed health problems

Asthma
Arthritis
Heart disease
Lung disease
High blood pressure
Low blood pressure
Shortness of breath
Blood cholesterol
Thyroid condition
Diabetic

Do you workout at the moment?

Yes
No

Are you a smoker

Yes
No

Are you pregnant

Yes
No

How many meals do you want to eat per day?

3
4
5
6

Rate your activity level

Selected Value: 0

0 Sitting most of the day (example: desk job).

MEAL PLAN

CHOOSE YOUR PROTEIN (Choose at least 4)

Beef
Lean Ground Beef
Fish
Chicken
Chicken Liver
Shrimp
Salmon
Tuna
Eggs
Greek Yogurt
Lentil
Whey Protein
Protein Bar
Protein Chips
Turkey Slices
Tofu
Cottage Cheese

CHOOSE YOUR CARBS (Choose at least 4)

Rice
Corn
Whole-Wheat Pasta
Whole-Grain Toast
Sourdough Toast
Sweet Potatoes
Oats
Cereal
Quinoa
Potato
Cream of Rice
Tortilla Wrap
Honey
Pitta Bread

CHOOSE YOUR FATS (Choose at least 4)

Avocado
Olives
Chia Seeds
Nuts
Almonds
Peanut Butter
Olive Oil
Dark Chocolate
Egg Yolks
Skimmed Milk
Almond Milk
Kitkat
Cheese

CHOOSE YOUR VEGETABLES (Choose at least 4)

Broccoli
Spinach
Tomatoes
Cucumbers
Mushrooms
Onions
Bell Pepper
Asparagus
Cauliflower
Bok Choy
Carrots
Betroot
Brussel Sprouts

CHOOSE YOUR FRUITS (Choose at least 4)

Banana
Apple
Orange
Watermelon
Mandarin
Kiwi
Berries
Pineapple
Papaya
Peaches
Cherries
Dragon Fruit
Cantaloupe
Pomegranate

Any Specific Food Style Preferences? (Optional)

Indian
Mediterranean
Western
Asian
Vegan
I'm ok with anything

Which foods do you love to indulge in for a cheat meal or refeed day?" (Check all that apply)

Pizza
Burger
Fries/Chips
Mac & Cheese
Sushi
Dumplings
Ice Cream
Donuts
Croissants
Cake
Fried Chicken / Wings

If there’s anything else in your mind, list it in the box below.

List all your bad habits, if you have any, that could help me tailor something specifically for you.

e.g., : I wake up 3am finish a box of chocolates by myself, I drink Alcohol every now and then

Why is it important for you to achieve your fitness goals right now, and what deeper ‘why’ fuels your commitment? *

e.g., energy for my busy life, a wedding, health risks, being strong for my kids, self-confidence, longevity

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