Bad A$$ Challenge

Welcome to your preliminary and exclusive nutritional questionnaire . Excuted by clinical dietitian & nutritionist Vicky Gomez from Healthy Empire in Collaboration with Fit2box Boxing Studio. The purpose of this questionnaire is to assist us in setting up your own personalized meal plan. This will help set you up for success and help us maximize your results over the 10 week BAD A$$ CHALLENGE .

Todays Date(Required)
Casual: Part Time: Full Time: Shift work: Not working Other
Office Worker: Labourer: Other
Is lunch prepared or purchased(Required)
Do you ever feel tired or fatigued throughout the day?(Required)
Live alone, Live with others, how many residents.
Are you the main cook?(Required)
Are you primary food shopper?(Required)
What results are you looking for out of this challenge?(Required)
On a scale of 1-10 with 10 been the hardest
Have you expirenced weightloss or gain in the past 3-5 years(Required)
Day 1: Day 2: Day:3
1: 2: 3: 4: 5:
1: 2: 3: 4: 5:
What time of the day do you find it the hardest to stick to your eating plan?(Required)
How much alcohol do you drink per week?(Required)
Thank you for taking the time to fill out this questionnaire, the information provided is confidential to Fit2box and body by Vicky Gomez. Information will be used to formulate your eating plan. I agree to allow uf to use this information to help you on your weightloss journey.

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