Kee's Klean Kreations

KEE’S KLEAN KREATIONS “Flavor On-the-Go!”

CLEAN PREPPED MEAL QUESTIONNAIRE
Please complete this questionnaire in order for me to better assist you in your journey to healthy eating! Any questions or concerns should be listed at the end of the form. Thank You!

Please fill out the following information.

* First Name :

* Last Name :

* Address 1 :

Address 2 :

* City :

* State :

* Zip :

* Phone :

* Email Address :

What is the best time to call?

*Preferred Contact Method:

Tell Me A Little About Yourself:

Do you consider yourself…

Underweight

Average Weight

Overweight

*Are you allergic to any foods? If YES, please list: (VERY IMPORTANT!)

What are some of your favorite foods (Fruits, Vegetables, Meats)?

What are some of your least favorite foods?

How much do you spend and how often do you eat FAST FOOD (McDonald’s, Burger King, Chick-fil-A, Sonic, Checkers...etc?)

Kee’s Klean Kreations 6/2014 IG: brownsuga75 or KK_ Kreations FB: Kisha Mosley Email: [email protected]