Info for custom diet form Your Name Your Phone Number Your Email (Required) Date of birth Your weight Your height Extra activities In the past week have you walked or bicycled to work, school, to do errands, or for leisure? Select answer (required) YesNo Activity Level Read the descriptions and choose your activity level from the options below. Consider how active you are on average. Sedentary The sedentary activity level includes activities of daily living, without additional exercise. These activities include housework, grocery shopping, walking the dog, walking to the bus, mowing the lawn, and gardening. Unless you do at least 30 minutes per day of intentional exercise, this level is for you! Low Active The low active activity level includes activities of daily living plus exercise that is equal to walking for 30 minutes at 4 miles per hour every day. For an adult of average weight, this amount of exercise will burn about 120 additional Calories. Exercises with less intensity (METS) will need to be performed longer to burn the same amount of Calories. Likewise, exercises with more intensity can be performed for less time to achieve the same goal. Active The active activity level includes activities of daily living plus exercise that is equal to walking for 1 hour 45 minutes at 4 miles per hour every day. For an adult of average weight, this amount of exercise will burn about 410 additional Calories. Very Active The very active activity level includes activities of daily living plus exercise that is equal to walking for 4 hours 15 minutes at 4 miles per hour every day. For an adult of average weight, this amount of exercise will burn about 1000 additional Calories. Select answer (required) SedentaryLow activeActiveVery active Tell us what you normally eat Please give us an example of what you would typically eat on a normal week day, and (if different) what you would eat on a weekend day. Example: Breakfast: 4 pieces of toast with jam, lunch: chicken salad, dinner: spaghetti bolognaise (big portion) snacks: Protein shake, banana, handful of almonds, iced latté. On weekends I loose all control: Breakfast at Denny's: Giant plate of pancakes with bacon and syrup, lunch: pizza and soda, dinner: All you can eat buffét at Sizzlers, 8 drinks at the bar, burrito and tub of ice cream before bed. (Be honest or we can´t help you correctly) What you normally eat: Tell us what Foods you prefer/don't like Please provide us with some intel to foods you like and don't like to eat. (So we can make the diet to your taste and liking as much as possible.) Example: I like rice, potatoes, bread, chicken, beef, salmon, tilapia, berries, apples, avocados, brokkoli and ice cream. I don't like quinoa, jams, cod, cabbage or pickles. Foods you like/ don't like: Use this box to tell us about any allergies, special requests, or concerns you might have regarding your diet, also your end goal. additional information Subject, put diet info and your first name Which is bigger, 3 or 9? After submitting please allow 1-4 business days before diet is completed and sent to your email.