Nutrition & Meal Planning Assessment Question Title * 1. Tell me about yourself Excited about life Generally a happy person Middle of the road Have experienced normal, but manageable life challenges Experienced life-altering challenges in life Question Title * 2. Please check all which apply. I maintain a healthy and balanced diet I exercise at least 3 times per week I receive annual physicals and regular check-ups I drink alcohol more than once per week I smoke cigarettes or tobacco regularly I have regular bowels movements (1-2 times per day) Question Title * 3. What are your current health and wellness goals? Shed weight Eat better/Eat healthier Manage a current physical condition Control appetite/Manage cravings Sleep better/Sleep more soundly Become more active/Increase fitness activity Learn how to prepare healthy meals Increase energy Manage emotional binge eating Question Title * 4. Do you consume the following daily? Check all which apply. Fresh Vegetables? (ex. Cucumber, Zucchini, Asparagus) Fresh Fruit? (ex. Apples, Berries, Citrus Fruits) Grains? (ex. Oats, Rice, Quinoa) Starches? (ex. Breads, Pasta, Potatoes) Leafy Greens? (Kale, Spinach, Collards) Nuts & Seeds? (Walnuts, Almonds, Sunflower seeds (not including nut butters) Clean Water? (at east 64 oz per day) Question Title * 5. Are you... Currently under a physician's care? Currently taking prescribed medications? Seeking to improve your overall health? Seeking ways to improve the health of your family? Taking any vitamins, supplements or under the advisement of a holistic medical practioner? Question Title * 6. Are you interested in receiving information about... Vegan Lifestyle (Plant-based, No animal or animal by-products (ex. no cheese, dairy, eggs) Vegetarian Lifestyle (Plant-based, but may include some dairy) Ovo-Vegetarian (Plant-based, but may include eggs in diet) Pescatarian (Plant-based, but may include fish and seafood in diet) Maintaining my current eating plan, but include more plant-based meals Question Title * 7. How often do you cook at home? Always Usually Sometimes Rarely Never Question Title * 8. Would you be interested in having a meal plan created just for you and/or your family? A customizable meal plan would include fresh, delicious, organic and naturally-sourced foods which is sodium, gluten, soy free and contains natural sugars. Recipes can be created to cut your cooking time in half without compromising flavor...and most meals can be prepared Raw-to-Ready in about 20 mins. Yes, I'm interested in learning more. No, I want to continue eating the foods I enjoy. Question Title * 9. Once you embark on your new wellness journey, who would be your support system? My spouse/partner My family (immediate or extended) A close friends/circle of friends My spiritual community A health and wellness group Question Title * 10. Please provide your email address. Completed