Menu Form Please Fill In The Form Below Menu Form Today's DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Disclaimer: These menus are meant as guidance. If you need medical nutrition therapy for a disease, these menus do not replace nutrition counseling for medical nutrition therapy. Check if you understand. I understand these menus are only nutritional guidance and do not replace individualized medical nutrition therapy. I understand that while the provided menus attempt to accommodate dietary restrictions and preferences, it may not be possible to incorporate all dietary modifications. Name First Middle Last Sex Male Female Date of BirthMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email Cell Number:Height (inches) Current weight (pounds) Target weight (pounds) Indicate your current activity level Restricted Sedentary (mostly sitting ) Exercise 3x weekly (30 or more minutes) Exercise 4x weekly (30 or more minutes) Exercise 5x weekly (30 or more minutes) Exercise 6-7x weekly (30 or more minutes) Daily exercise exceeding 45 minutes Training for a marathon, triathlon Indicate your nutritional goals Lactose free or low lactose Gluten free Carbohyrate modified Higher protein Vegetarian Emphasis on plant based Lower sodium Antioxidant rich Weight gain Weight loss Please provide a short list of your favorite foodsPlease provide a short list of foods you will not eat.Please provide any other information you think is important. Δ
