Meal Plan Questionnaire

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- Step 1 of 9

Name *

First

Last

Email *

Phone *

Section Divider

1. Chicken *

Thigh
Breast
Wings
Drumsticks
Not Applicable

How Often Do You Eat Chicken? *

2. Beef *

Mince
Steak
Fillet
Biltong
Lean/ Venison Biltong
Not Applicable

How Often Do You Eat Beef? *

3. Pork *

Bacon
Fillet
Loin, Lean Only
Not Applicable

How Often Do You Eat Pork? *

4. Fish *

Hake
Basa
Tuna In Water
Mackerel
Salmon Tinned
Sardines In Tomato Sauce
Salmon Fresh
Trout
Sole
Kabeljou
Anchovy
Cob
Haddock
Mussels
Prawns
Shrimp
Cockles
Oysters
Crab
Crayfish
Not Applicable

How Often Do You Eat Fish? *

5. Venison *

Ostrich Mine
Ostrich Steak
Venison Mince
Venison Sausage
Not Applicable

How Often Do You Eat Venison? *

6. Egg *

Scrambled
Boiled Only
Poached
Not Applicable

7. Soya *

Soya Mince
Tofu
Tempeh
Edamame beans
Not Applicable

8. Dairy *

Yoghurt
Milk
Feta Cheese
Cheddar Cheese
Mozarella Cheese
Cottage Cheese
Maas
Not Applicable

Yoghurt *

Milk *

9. Dairy Alternatives *

Soy Milk
Almond Milk
Rice Milk
Lactose Free Clover Milk
Lactose Free Yoghurt
Oat Milk
Coconut Milk
Rice Milk
Macadamia Milk
Not Applicable

Any other protein food you would like in your meal plan?

Carbohydrates *

Bread
Wraps
Rice Cakes
Ryvita
Provita
Crackers
Oats
Cereal
Rice
Quinoa
Couscous
Samp
Popcorn
Not Applicable

Bread *

Rice *

List All Cereals You Eat *

Any other carb item you would like in your meal plan?

Legumes *

Hummus
Chickpeas
Sugar Beans
Lentils
Kidney Beans
Butter Beans
Split Peas
Cannelinni Beans
Baked Beans
Not Applicable

Any other legume item you would like in your meal plan?

Fat *

Avocado
Mayonnaise
Olives
Olive Oil
Peanut Butter
Other Macnut Butters
Cashews
Almonds
Brazil Nuts
Walnuts
Pecan Nuts
Peanuts
Flaxseed
Sesame Seed
Pumpkin Seed
Hemp Seeds
Sunflower Seeds
Chai Seeds
Almond Butter
Cashew Butter
Walnut Butter
Pecan Nut Butter
Not Applicable

If you have not selected any of the seeds, would you consider trying them due to their health benefits? *

Yes
No

Any other fat item you would like in your meal plan?

Vegetables *

Broccoli
Spinach
Kale
Lettuce
Cauliflower
Green Beans
Sweetcorn
McCain Frozen Vegetables
Peas
Carrots
Beetroot
Onion
Bell Peppers
Mushrooms
Baby Marrows
Cabbage
Brussel Sprouts
Tomato
Cucumber
Artichoke
Asparagus
Brinjal
Celery
Turnip
Radish
Leeks
Not Applicable

Any other vegetable item you would like in your meal plan?

Starchy Vegetables *

Potato
Sweet Potato
Sweet Potato Chips
Butternut
Gem Squash
Not Applicable

Any other starchy vegetable item you would like in your meal plan?

Fruit *

Apple
Banana
Pear
Strawberry
Blueberry
Mixed Berries
Pineapple
Pawpaw
Grapes
Orange
Naartjie
Nectarine
Grapefruit
Kiwi
Peach
Cherries
Dates
Figs
Guava
Lemon
Mango
Raisins
Plums
Not Applicable

Any other fruit item you would like in your meal plan?

1. Do you have any confirmed allergies? *

2. Do you have an intolerance to? *

Gluten
Lactose
None

Would you like these excluded from your meal plan? *

Yes
No

Would you like these items limited in your meal plan *

Yes
No

3. Are you happy with the following in your meal plan *

Smoothies
Oats
Whey Protein
None

5. Do you? *

Have Lots Of Time To Prepare Your Meals
Shop & Make Your Own Food?
Please Consider A Tight Budget
Not Applicable

Please List Excluded items

6. Would You Like? *

Snacks
Easy To Prepare Meal Options
Repetition For Convenience's Sake

7. Foods Or Treats You Feel Like You Can't Live Without Or Would Like Included In Your Meal Plan? *

Dark Chocolate
Rusks
Jelly & Custard
Hot Chocolate
Other
None

Please List Any Other Items You Would Like Included *

8. Please List Any Food You Will NOT Eat *

11. Any Other Food/Recipe/Drink You Would Like Us To Consider? *