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F.U.N. Meals By Jen

Questionnaire

Please complete the following survey, answering the questions to the best of your ability in order to provide you with the best service possible.

1. Describe your typical day. For example, I wake up at 7 am, eat breakfast, work from 8-5 with lunch in between, go to the gym, and then go home to take care of children and have dinner

2. What are your top favorite foods,unhealthy and healthy, such as pizza, cheesesteaks, broccoli, green beans

3. What foods (and spices) do you strongly dislike?

4. How many times do you eat out and/or order take out within a month and where do you go?

5. How often do you prepare your own meals? For example, I make dinner every day of the week but eat out for lunch and dinner on the weekends, or I cook 75% of my meals

6. What types of food do you typically keep in the house?
Look at the items in the fridge, freezer and pantry. Please be specific and list as much as possible, especially items that are packaged in a can or box. Example, brown rice vs white, instant, rolled vs steel cut oats, chicken breast vs beef

7. How frequently do you eat fruits and vegetables?

Please enter an 'other' value for this selection.

8. Copy of How frequently do you eat fruits and vegetables?

Please enter an 'other' value for this selection.

9. How much water do you drink in a day? Please also indicate how often you drink soda & other beverages

Please enter an 'other' value for this selection.

10. Describe your activity level

11. Copy of Describe your activity level

12. Are you allergic or sensitive to any foods?

13. What is your biggest challenge right now and what do you hope to accomplish? Please be as detailed and specific as possible

14. Please provide your contact information *This question is required.

First Name

Last Name

Email Address

Phone Number

15. Anything else I should know? Please include additional comments below.

Never enter passwords or other sensitive information on this form. Report Abuse

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