Nutrition Service Sign Up

STEP 2 – Meal Plan ( You can continue onwards to Step 3 -Exercise Plan)

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 Telephone Number:

Other Telephone:

Your Gender:
MaleFemale

Your Age:

Your Occupation:

Your Address:

Your Supermarket:

Health Assessment Data

Your Blood glucose:

Your Blood Pressure:

Your Occupation:

Your HbA1c:

Your Weight:

Your Height:

Your BMI:

Your Body Fat:

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?

How Often Do you Exercise?

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:

Estimated Body Fat Percentage (If Known):

Daily Activity Level (Outside of the gym):

Average Hours of Sleep Per Night:

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

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:

Do you practice Intermittent Fasting?

Where do you eat most of your meals during the week

Cooking Skill Level:

Daily Meal Prep Time Available:

How do you usually prepare your food?

Food Budget Preference:

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?

How often do you consume vegetables?

How often do you consume legumes? (e,g lentil pea, chickpeas, etc.)?

How often do you eat nuts? (E.g. peanuts, almonds, walnuts, etc.)?

How often do you eat ultra- processed meat? (E.g. hotdogs, bacon, etc.)?

How often do you drink milk?

How often do you eat cornflakes? (e.g. Frosted Flakes, Cinnamon Toast Crunch, etc.)?

How often do you eat cereals? (e.g. oats, cream of wheat, barley)?

How often do you eat rice (e.g. brown rice, white rice, jasmine rice etc.)?

How often do you eat starchy foods? (E.g., potatoes (English, sweet, pumpkin, yams, etc)?

How often do you eat bread? (E.g. white, whole wheat, etc.)?

How often do you eat eggs?

How often do you eat meat? (Chicken, pork, beef, etc.)?

How often do you eat fish? (Flying fish, dolphin, shark etc.)?

How often do you use biscuits? (E.g. Eclipse, Sodabix, Envita etc.)?

How often do you use bread? (E.g. Whole wheat, white, salt bread, etc.)?

How often do you use butter? (E.g. sunflower, margarine, etc.)? (E.g. Whole wheat, white, salt bread, etc.)?

How often do you eat pastries? (croissants, jam puffs, meat rolls, donuts etc.)? (E.g. sunflower, margarine, etc.)?

How often do you consume fried foods (chips, chicken, fish, etc)?

How often do you consume fast foods (KFC, Chefette, Burger King)

How often do you consume snacks (eg.,Corncurls, Shirley’s, potato chips, etc)?

How often do you consume sweets/candy (e.g chocolate, lollipops, mints, etc)?

How often do you consume sugar-sweetened beverages (soft drinks)?

How often do you consume energy drinks?

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 supplements

Are you on any medications?:

Would you be willing to Review this Nutrition Service:

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

First Fitness GYM