One-Off Meal Plan Form🥘 Name First Last Email Gender Female Male AgeWeight (kg)Height (cm)What is your job activity level? Sedentary (seated) Active (some walking) Heavy Labor (very active/physical) What is your main goal you are wanting to work towards?Do you watch your eating habits? Yes no What does a typical day of eating look like for you?*including foods you eat + snacks and what times of the dayWhat foods would you like to see in your meal plan?Are there any foods you dislike and/or do you have any food allergies or intolerances?How many caffeinated beverages do you drink per day?How much water do you drink per day?How many times per week do you drink alcohol? Never OR special occasions only 1-2 3+ Do you take any supplements?If yes, please list. Are you on any medications, if so please list?On average, how many hours of sleep do you get per night?How would you rate your energy levels during the day? Very poor Average Very good If any, please list any habits you would like to get rid of..If any, please list any habits or lifestyle changes you would like to start?How many times per week do you exercise?What time of the day do you normally exercise?What kind(s) of exercise/movement do you do and how often?Eg - weights at gym 3 x p/w, classes, running, cardio, pilates, yoga etc.Do you have any injuries or illness that I should know about that may affect your ability to follow the plan?Please rate your readiness to make a change 1-3 4-6 7-9 10 Disclaimer(Required) I agree to the below disclaimer:At Ash Mullen Fitness we believe you should consult your physician or other health care professional before starting this or any other fitness plan/program to ensure you are safely able to do so. This is particularly true if you (or your family) have a history of high blood pressure or heart disease, if you have experienced chest pain when exercising or in the past month when not engaged in any physical activity, have high cholesterol, are obese, or have a bone or joint problem that could be made worse by a change in physical activity. Do not start this fitness plan/program if your physician or health care provider advises against it. If you experience faintness, dizziness, pain or shortness of breath at any time while exercising you should stop immediately. At Ash Mullen Fitness we offer health, fitness and nutritional information and recommendations that is designed for educational purposes only. You should not rely on this information as a substitute for, nor does it replace, professional medical advice, diagnosis, or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other health-care professional. Do not disregard, avoid or delay obtaining medical or health related advice from your health-care professional because of something you may have read on your plan/program. Your plan/program has been customised to you and your lifestyle. By accepting the terms you agree not to share or sell to anyone else. The use of any information provided by Ash Mullen Fitness is solely at your own risk. Δ