Client Questionnaire

If you have or in the past have struggled with body image issues, fear of consuming certain foods or gaining weight please share that with me as well. Health is not just about the body, but the mind as well!

Please list any additional information you'd like to share with me that you feel would be relevant to your program design.

Please select all the food items you Do Not want included in your meal plan...

Proteins

Beef (ground) 93/7Beef (ground) 96/4ChickenCottage Cheese 0%CrabEggEgg WhitesFish (cod)Fish (salmon)Fish (tilapia)Fish (tuna steak)Fish (tuna caned)Greek Yogurt 0%Greek Yogurt (light and fit)OystersPork LoinScallopsShrimpSteak (strip)Steak (filet)Turkey (ground) 93% leanTurkey (ground) 99% leanVenison

Fats

Almond ButterAlmondsAvocadoBaconButterCanola OilCashewsCheese (Blue)Cheese (Cheddar)Cheese (Feta)Cheese (Goat)Cheese (Mozzarella)Cheese (Provolone)Cheese (Swiss)Coconut OilFlaxseedHalf and HalfOlive OilPeanut ButterPeanutsPine NutsSausage (Pork)Sour CreamSunflower Seed ButterWalnuts

Fruits

AppleApricotBlackberriesBlueberriesCantaloupeCherriesDatesGrapesHoneydewKiwiMangoOrangePeachPearPineapplePlumRaspberriesStrawberriesWatermelon

Vegetables

AsparagusBroccoliBrussels SproutsCarrotsCauliflowerCeleryCucumberGreen beansKaleLettuceMushroomsOnionPeasPeppersSpinachTomatoZucchini/ Summer Squash

Carbs

Bagel (everything)Bagel (whole wheat)Baked Potato ChipsBeans (black)Beans (pinto)Bread (Ezekiel)Bread (wheat)Bread (white)Brown Rice (cooked)Cereal (chex)Cereal (cinnamon toast crunch)Corn (cooked)Couscous (cooked)Cream of Rice (dry)English MuffinGranolaGrits (dry)Ice Cream (Edys slow churned)Ice Cream (halo top)Oats (dry)Oat Bran (dry)Orzo (dry)Pancake Mix (dry)Pasta (wheat,dry)Popcorn (unpopped)Potatoes (sweet) rawPotatoes (white) rawQuinoa (cooked)Ricecake (plain)Ricecake (chocolate)Ricecake (caramel)Squash (acorn) rawSquash (butternut) rawSquash (spaghetti) rawTortillas (corn)Tortillas (flour)