Fitness Jay Nutrition Questionnaire

* First and last name?

* Current age?

* Email you want to receive your meal plan?

* Current Height?

* Current Weight? (lbs)

* Any Food Allergies?

* Are there any foods you will absolutely not eat?

* Do you cook for yourself or family?

* Are you employed? If so, what kind of job do you work? (Office, Outdoor, at home?) Is it a typical 9-5 with 30 minute to 1 hr lunch? Does your job give you access to a microwave and fridge?

* What are your health/fitness goals? (Be very detailed, Gain weight, lose weight- how many lbs? Maintain healthy balance, etc)

* Do/Will you be exercising? (If so, list day & time)

* Please provide a 1-2 day food diary of a typical day of eating for you. This would include everything you eat including quantities and time of day you eat them. This gives me a better understanding of where you currently are with nutrition.