MEMBER MANAGEMENT
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Name (First & Last)
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Email
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Primary Diet Type
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Anything
Paleo
Vegetarian
Vegan
Atkins/ Ketogenic
Zone (30/40/30)
A. Common Allergies (Check all that apply)
(required)
Gluten
Tree Nuts
Peanuts
Dairy
Eggs
Soy
Fish
Shellfish
NO FOOD ALLERGIES
B. Please check ONLY the foods you DO NOT like. If left blank, we will assume you like these foods.
(required)
All Red meat
Beef
Pork/ Bacon
Lamb
Veal
All Poultry
Chicken
Turkey
All Fish
Salmon
Tuna
Tilapia
Sardines
Trout/ Snapper
All Shellfish
Eggs
Mayo
Honey
All Soy
Tofu
Soy Milk
All Grains
Breakfast Cereals
Pastas
Breads
Rice
Oatmeal
Sugar
All Legumes
Beans
Lentils
Peas
All Starchy Vegetables
Potatoes/ Yams
Corn
All Fibrous Vegetables
Atrichokes
Asparagus
Beets
Broccoli
Carrots
Sprouts
Celery
Peppers
Tomato
Eggplant
Fats & Nuts
Avocado
Peanuts
Almonds
Walnuts
Pecans
All Dairy
Milk
Cream
Cheese
Yogurt
Cottage Cheese
Whey Protein Powder
All Fruit
Apple
Banana
Grapes
Orange
Strawberries
Raspberries
Blueberries
Fruit Juice
NO FOOD DISLIKES
Please type any additional food restrictions, allergies or dislikes below (or N/A):
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Please list any special foods you would like to include on a regular basis. Include brand names if possible. (or N/A)
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COMMENTS (or N/A):
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