Custom Meal-Plan Form

Name

First Name

Last Name

Weight-Related Goal

Age

Gender

Current Weight

(a rough estimate is completely okay!)

Height

(Feet and inches)

Activity Level

Sedentary — You work a desk job with little or no exercise. Lightly Active — You work a job with light physical demands, or you work a desk job and perform light exercise (at the level of a brisk walk) for 30 minutes per day, 3-5 times per week . Moderately Active — You work a moderately physically demanding job, such as a construction worker, or you work a desk job and engage in moderate exercise for 1 hour per day, 3-5 times per week. Very Active — You work a consistently physically demanding job, such as an agricultural worker, or you work a desk job and engage in intense exercise for 1 hour per day or moderate exercise for 2 hours per day, 5-7 times per week. Extra Active — You work an extremely physically demanding job, such as a professional athlete, competitive cyclist, or fitness professional, or you engage in intense exercise for at least 2 hours per day.

List any foods or ingredients that you do not consume or that you strictly limit. I will make an effort to ensure that these do not appear in your meal plan.

Please include any and all allergies, intolerances, cultural/religious rules, or food groups you do not eat for any other reason [such as meat, fish, etc].

Acknowledgments

Partake Meal Plans are formulated to achieve an average calorie intake that matches your goal of weight-maintenance or weight-loss. The information you provide is used to generate an estimate of your energy needs using a commonly-referenced Total Energy Expenditure formula (which can be accessed here: http://www.thedietfix.com/calculator.aspx ). For more information about how this is incorporated into your custom plan, please send me an email at megan.e.gaul@gmail.com.

By accessing this meal plan from Partake, you are acknowledging that the Total Energy Expenditure estimate provides general reference information only, and is not intended as a substitute for consulting with your physician or other healthcare professionals. Please make sure to consult with your physician or other healthcare professionals before you change your diet.

I acknowledge that I may receive emails related to this meal plan, as well as future purchases, free offerings, upcoming events, and new services from Partake Meal Planning and Wellness.