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Feed My Belly Meal Plan Intake

Please answer as honestly and completely as possible — your answers are how we build a plan that actually works for your life and your goals.

Note: This service is not a substitute for medical advice. Please consult your doctor before making significant dietary changes, especially if you are managing a medical condition or taking medications.

Full Name

Email Address

Family & Lifestyle

Who are you cooking for?

Just myself

Myself and a partner

Myself and children

Myself, a partner, and children

How many adults will this meal plan feed?

How many children will this meal plan feed?

What are the ages of your children? (so we can make sure meals are kid-friendly)

How picky are your kids when it comes to food?

Not picky — they'll eat almost anything

Somewhat picky — a few things they won't touch

Very picky — limited foods they'll accept

N/A — no children

How much time do you have to prepare meals on a weekday?

Less than 15 minutes

15–30 minutes

30–45 minutes

45–60 minutes

I enjoy cooking and have plenty of time

How do you handle leftovers?

We eat leftovers for lunch the next day

We eat leftovers for dinner the next night

Adults take leftovers to work

Kids take leftovers to school

We rarely eat leftovers

We batch cook and eat the same meal multiple times

Food Preferences & Dislikes

Do you have any food allergies or dietary restrictions?

Yes

Please list your food allergies or dietary restrictions

How would you describe your current diet?

Omnivore (eat everything)

Flexitarian (mostly plant-based with occasional meat/fish)

Pescatarian (fish, no meat)

Vegetarian (no meat, but eat dairy/eggs)

Vegan (no animal products)

Which cuisines do you enjoy? Check all that apply.

Are there any cuisines you dislike or want to avoid?

How would you describe your flavor preferences? Check all that apply.

Which of these meal styles do you enjoy? Check all that apply.

Are there any foods you strongly dislike or refuse to eat?

Are there any foods you love and would be happy to eat regularly?

Are you open to trying new foods and recipes?

Yes, I love trying new things!

Somewhat — I prefer familiar foods with small tweaks

I prefer sticking to what I know

Any cultural or religious food preferences we should be aware of?

Kitchen & Budget

How would you describe your cooking skill level?

Beginner — I rarely cook

Basic — I can follow simple recipes

Intermediate — I'm comfortable in the kitchen

Advanced — I love to cook and experiment

What equipment do you have? Check all that apply

What is your approximate weekly grocery budget?

Under $100

$100–$150

$150–$200

$200+

Do you shop at any specific stores or have limited access to certain stores?

Your Schedule & Lifestyle

How do you prefer to receive your meal plan?

Full weekly plan — tell me exactly what to cook each day

Recipe collection — give me recipes and I'll plan my own week

Hybrid — give me a plan but I'm flexible with it

Which meals would you like included in your plan?

Do you meal prep in advance?

Yes, regularly

Sometimes

No, but I'm willing to learn

No and I prefer not to

How many times per week does your family typically cook dinner?

7 nights — we cook every night

5–6 nights — mostly home cooked

3–4 nights — mix of cooking and leftovers

1–2 nights — we rely heavily on leftovers and easy meals

Health Goals

Which of the following are health goals for you? Check all that apply.

Weight & Body Composition

Lose weight

Reduce belly fat / visceral fat

Maintain a healthy weight long-term

Energy & Vitality

Increase daily energy levels

Reduce chronic fatigue

Improve mental clarity and focus

Improve physical stamina and endurance

Heart & Metabolic Health

Lower cholesterol (LDL/triglycerides)

Reduce blood pressure

Reverse or manage Type 2 Diabetes / Pre-Diabetes

Reduce heart disease risk

Improve blood sugar stability

Gut & Digestive Health

Improve digestion and reduce bloating

Relieve constipation or irregularity

Manage IBS, Crohn's, or colitis symptoms

Improve gut microbiome health

Reduce acid reflux / GERD symptoms

Hormonal & Women's Health

Relieve menopause symptoms

Balance hormones naturally

Manage perimenopause symptoms

Improve bone density / reduce osteoporosis risk

Reduce PMS symptoms

Sleep & Stress

Improve sleep quality

Reduce chronic stress

Improve mood and emotional wellbeing

Reduce brain fog

Skin & Aging

Improve skin health and clarity

Strengthen hair and nails

Lifestyle & Prevention

Build sustainable healthy eating habits

Improve immune function

Set a healthy example for my family

What are your TOP 3 health priorities right now?

What has prevented you from reaching your health goals in the past?

Body Composition

This section only applies if weight loss or body composition is one of your goals.

What is your height?

What is your current weight?

What is your age?

What is your goal weight? (optional)

How would you describe your current activity level?

Sedentary (little to no exercise)

Lightly active (1–2 days/week)

Moderately active (3–4 days/week)

Very active (5+ days/week)