Nutrition Form

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2

STEP 2 OUT OF 3

6 Weeks Package

Name *

First

Last

Gender *

Date of birth

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

Please list any current or past injuries that could prevent certain activities:

Back Problems
Muscle disorder
Joint dislocation
Tendon/ Ligament Tear
Recent Surgery (last 12 months)

Do you workout at the moment?

Yes
No

Are you a smoker

Yes
No

Are you pregnant

Yes
No

Rate your activity level

Selected Value: 0

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

MEAL PLAN

CHOOSE YOUR PROTEIN

Beef
Lean Ground Beef
Fish
Chicken
Salmon
Tuna
Eggs
Greek Yogurt

CHOOSE YOUR CARBS

Rice
Corn
Whole-Wheat Pasta
Whole-Grain Toast
Sweet Potatoes
Oats
Quinoa
Potato

CHOOSE YOUR FATS

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

CHOOSE YOUR VEGETABLES

Broccoli
Spinach
Tomatoes
Cucumbers
Mushrooms
Onions
Pepper
Asparagus
Brussel Sprouts

CHOOSE YOUR FRUITS

Banana
Apple
Orange
Watermelon
Kiwi
Berries
Pineapple

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Email

fILL UP THE FORM

2

STEP 2 OUT OF 3

MEAL PLAN

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