Intake form

Name *

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What is your primary goal for seeking wellness assistance?

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Weight Loss

Healthy Eating

Meal Planning

Lifestyle Change

Fitness Improvement

What dietary preferences do you follow?

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Vegetarian

Vegan

Gluten-Free

Keto

Paleo

How often do you eat out at restaurants?

What type of recipes are you most interested in?

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Breakfast

Lunch

Dinner

Snacks

Desserts

How did you hear about us?

What challenges have you faced with your current eating habits?

Which service or services are you interested in?

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High-protein recipe development

Grocery haul guidance

Healthy fast-food guides

Additional questions or comments

Wellness News Report