First Fitness Gym

By completing this questionnaire, you consent to First Fitness Inc. collecting and using your health information to provide personalized wellness recommendations, nutrition plans, and follow-up services. This questionnaire is intended for health screening and wellness purposes and does not provide a medical diagnosis or replace advice from a qualified healthcare professional.

Your Name:

Your Email (Used to Return your Meal Plan):

Your Occupation:

Your Address:

Supermarkets you shop at:

Select your Fitness Goals:
NoneLose Body FatWeight LossWeight GainMaintain Current WeightImprove My Body's PhysiqueImprove HealthBuild muscleTo Gain StrengthStress ReliefRehabilitation (Recover from Illness)Managing DiseaseImprove Athletic PerformanceIncrease stamina and EndureIncrease Daily Energy Levels

How would you describe your daily activity level?
NoneSedentary (little to no moving around, work a desk)Light Active (light exercise 1-3 days per week)Moderately Active (moderate 3-5 days of exercise)Very active (6-7days)Extremely active

How Often Do you Exercise?
Multiple Times DailyOnce Daily5+ days/week3–4 days/Week1–2 days/WeekOnce a MonthNever

What type of exercise do you usually do?
Free WeightsFixed ResistanceCardio (Running, Walking Treadmill, Bike, etc.)Group Classes (Spin, Zumba, etc.)Holistic (Yoga, Mobility, Pilate etc.)None

Your Target Weight:

Daily Activity Level (Outside of the gym):
NoneSedentary (Desk job, very little movement)Lightly Active (Desk job but I walk around occasionally)Moderately Active (On my feet a lot, e.g., retail, nursing, teaching)Very Active (Physical labor job, e.g., construction, landscaping)

Average Hours of Sleep Per Night:
Under 5 hours5 – 6 hours7 – 8 hours9+ hours

Check all that apply to your eating style, Current Dietary Style:
[checkbox* “No Preference” Eating-Style ” Vegetarian (No meat, but eat dairy/eggs)” “Vegan (No animal products)” “Pescatarian (Vegetarian + Seafood)” “Paleo (unprocessed foods – hunted, fished or gathered)” “Gluten-Free” ]

Food Allergies or Severe Intolerances (Check all that apply):
NoneGluten / WheatDairy / LactoseEggsSoyNuts / PeanutsShellfishFish

List Other Foods I Avoid:

List Type of Diets You Are On:

Medical Conditions Affecting Diet (Check all that apply):

NoneType 1 or Type 2 DiabetesHigh Blood Pressure/HypertensionHigh CholesterolIBS / Digestive Issues (Bloating, gas, etc.)Acid Reflux / GERDPCOS (Polycystic Ovary Syndrome)Thyroid ConditionKidney DiseaseGastrointestinal DiseaseCardiovascular Diseases

Preferred Number of Meals Per Day:
One Meal2 Large Meals (e.g., Skip breakfast)3 Standard Meals (Breakfast, Lunch, Dinner)4 Meals (Standard meals + 1 snack)5+ Smaller Meals

Do you practice Intermittent Fasting?
NoYes – 16:8 (16 hours fasting, 8 hours eating)Yes – 18:6 (18 hours fasting, 6 hours eating)Yes – 20:4 (20 hours fasting, 4 hours eating)

Where do you eat most of your meals during the week
I cook almost all my meals at homeI eat at a work/school cafeteriaI eat out at restaurants or get takeout frequentlyA mix of home-cooked and takeout

Cooking Skill Level:
I Can't/don't CookBeginner (I burn water / Use microwave only)Intermediate (I can follow a recipe and cook basics like chicken and rice)Advanced (I enjoy cooking complex meals from scratch)

Who Cook your meals:
MyselfParentPartnerRelativeFriendNeighbour

Daily Meal Prep Time Available:
I don't have time to cookLess than 15 minutes15 – 30 minutes15 – 30 minutes30 – 60 minutesI have plenty of time to cook

What Cooking Equipment is used to prepare your meals:
[select* Cooking_Equipment “Stove” “Microwave” “Air fryer” “Pressure Cooker” “Rice Cooker” “Slow Cooker” “Toster Oven” “None Dont Prepare Meals]

How do you usually prepare your food?
No PreferenceBakedFryAir-fryRoastBoilSteamGrill

Food Budget Preference:
Budget-friendly (Cheaper cuts of meat, basic staples)Moderate (Willing to spend a bit more for convenience like pre-cut veggies)Flexible / Premium (Organic, grass-fed, wild-caught, etc. is preferred)

Food Likes and Likes and Dislikes

Proteins you enjoy:
NoneChicken Breast / ThighsLean Beef (Sirloin, 93% lean ground)Fatty Beef (Ribeye, 80% lean ground)Pork (Chops, Tenderloin)Turkey (Ground, Deli meat)Salmon / Fatty FishWhite Fish (Tilapia, Cod, Tuna)Shrimp / SeafoodEggs / Egg WhitesGreek Yogurt / Cottage CheeseProtein Powder (Whey, Casein, Plant-based)

Carbohydrates you enjoy:
NoneWhite RiceBrown Rice / QuinoaOatmealPotatoes (White)Sweet Potatoes / YamsPasta / SpaghettiBread / Wraps / BagelsFruit (Bananas, Berries, Apples, etc.)Beans / Lentils / Legumes

Fats you enjoy:
NoneAvocados / GuacamoleOlive Oil / Avocado OilPeanut Butter / Almond ButterNuts (Almonds, Walnuts, Cashews)Seeds (Chia, Flax, Sunflower)CheeseButter

Vegetables you enjoy:
NoneBroccoliSpinach / KaleAsparagusGreen BeansBell Peppers / OnionsZucchini / SquashCarrots / Peas / CornSalads (Mixed greens)

Popular Foods

How often do you consume fruits?
NeverOnce a month2 times per month3 times per monthOnce a week2 times per weekMore than 3 times per weekOnce a day2 times per dayMore than 2 times per day

How often do you consume vegetables?
NeverOnce a month2 times per month3 times per monthOnce a week2 times per weekMore than 3 times per weekOnce a day2 times per dayMore than 2 times per day

How often do you consume legumes? (e,g lentil pea, chickpeas, etc.)?
NeverOnce a month2 times per month3 times per monthOnce a week2 times per weekMore than 3 times per weekOnce a day2 times per dayMore than 2 times per day

How often do you eat nuts? (E.g. peanuts, almonds, walnuts, etc.)?
NeverOnce a month2 times per month3 times per monthOnce a week2 times per weekMore than 3 times per weekOnce a day2 times per dayMore than 2 times per day

How often do you eat ultra- processed meat? (E.g. hotdogs, bacon, etc.)?
NeverOnce a month2 times per month3 times per monthOnce a week2 times per weekMore than 3 times per weekOnce a day2 times per dayMore than 2 times per day

How often do you drink milk?
NeverNeverOnce a month2 times per month3 times per monthOnce a week2 times per weekMore than 3 times per weekOnce a day2 times per dayMore than 2 times per day

How often do you eat cornflakes? (e.g. Frosted Flakes, Cinnamon Toast Crunch, etc.)?
NeverOnce a month2 times per month3 times per monthOnce a week2 times per weekMore than 3 times per weekOnce a day2 times per dayMore than 2 times per day

How often do you eat cereals? (e.g. oats, cream of wheat, barley)?
NeverOnce a month2 times per month3 times per monthOnce a week2 times per weekMore than 3 times per weekOnce a day2 times per dayMore than 2 times per day

How often do you eat rice (e.g. brown rice, white rice, jasmine rice etc.)?
NeverOnce a month2 times per month3 times per monthOnce a week2 times per weekMore than 3 times per weekOnce a day2 times per dayMore than 2 times per day

How often do you eat starchy foods? (E.g., potatoes (English, sweet, pumpkin, yams, etc)?
NeverOnce a month2 times per month3 times per monthOnce a week2 times per weekMore than 3 times per weekOnce a day2 times per dayMore than 2 times per day

How often do you eat bread? (E.g. white, whole wheat, etc.)?
NeverOnce a month2 times per month3 times per monthOnce a week2 times per weekMore than 3 times per weekOnce a day2 times per dayMore than 2 times per day

How often do you eat eggs?
NeverOnce a month2 times per month3 times per monthOnce a week2 times per weekMore than 3 times per weekOnce a day2 times per dayMore than 2 times per day

How often do you eat meat? (Chicken, pork, beef, etc.)?
NeverOnce a month2 times per month3 times per monthOnce a week2 times per weekMore than 3 times per weekOnce a day2 times per dayMore than 2 times per day

How often do you eat red meat? (Lamb, Pork etc.)?
NeverOnce a month2 times per month3 times per monthOnce a week2 times per weekMore than 3 times per weekOnce a day2 times per dayMore than 2 times per day

How often do you eat fish? (Flying fish, dolphin, shark etc.)?
NeverOnce a month2 times per month3 times per monthOnce a week2 times per weekMore than 3 times per weekOnce a day2 times per dayMore than 2 times per day

How often do you use biscuits? (E.g. Eclipse, Sodabix, Envita etc.)?
NeverOnce a month2 times per month3 times per monthOnce a week2 times per weekMore than 3 times per weekOnce a day2 times per dayMore than 2 times per day

How often do you use bread? (E.g. Whole wheat, white, salt bread, etc.)?
NeverNeverOnce a month2 times per month3 times per monthOnce a week2 times per weekMore than 3 times per weekOnce a day2 times per dayMore than 2 times per day
How often do you use butter? (E.g. sunflower, margarine, etc.)? (E.g. Whole wheat, white, salt bread, etc.)?
NeverOnce a month2 times per month3 times per monthOnce a week2 times per weekMore than 3 times per weekOnce a day2 times per dayMore than 2 times per day

How often do you eat pastries? (croissants, jam puffs, meat rolls, donuts etc.)? (E.g. sunflower, margarine, etc.)?
NeverOnce a month2 times per month3 times per monthOnce a week2 times per weekMore than 3 times per weekOnce a day2 times per dayMore than 2 times per day

How often do you consume fried foods (chips, chicken, fish, etc)?
NeverOnce a month2 times per month3 times per monthOnce a week2 times per weekMore than 3 times per weekOnce a day2 times per dayMore than 2 times per day
How often do you consume fast foods (KFC, Chefette, Burger King)
NeverOnce a month2 times per month3 times per monthOnce a week2 times per weekMore than 3 times per weekOnce a day2 times per dayMore than 2 times per day

How often do you consume snacks (eg.,Corncurls, Shirley’s, potato chips, etc)?
NeverOnce a month2 times per month3 times per monthOnce a week2 times per weekMore than 3 times per weekOnce a day2 times per dayMore than 2 times per day
How often do you consume sweets/candy (e.g chocolate, lollipops, mints, etc)?
NeverOnce a month2 times per month3 times per monthOnce a week2 times per weekMore than 3 times per weekOnce a day2 times per dayMore than 2 times per day
How often do you consume sugar-sweetened beverages (soft drinks)?
NeverOnce a month2 times per month3 times per monthOnce a week2 times per weekMore than 3 times per weekOnce a day2 times per dayMore than 2 times per day

How often do you consume energy drinks?
NeverOnce a month2 times per month3 times per monthOnce a week2 times per weekMore than 3 times per weekOnce a day2 times per dayMore than 2 times per day

List your most Favourite Foods:

Hydration & Supplementation

Daily Water Intake:
Less than 32 oz (1 Liter)32 oz – 64 oz (1 – 2 Liters)64 oz – 96 oz (2 – 3 Liters)Over 1 Gallon (3.5+ Liters)

Daily Beverages:
Water onlyBlack Coffee / Plain TeaCoffee/Tea with sugar, cream, or flavored syrupsDiet Sodas / Zero-calorie energy drinksRegular Sodas / Sugary DrinksAlcohol (1-2 drinks nightly/often)

Current Supplements:
Creatine MonohydratePre-Workout / CaffeineFish Oil / Omega-3sMultivitaminVitamin AVitamin BVitamin CVitamin DIronMagnesiumZincBCAAs / EAAsProtein powersHerbal supplementsNone

Are you on any medications?:

Would you be willing to Review this Nutrition Service:
YESNO

I consent to submitting my medical data strictly to generate my meal plan:
YES