BODY IMPACT MEAL PLAN INTAKE FORM

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**After receiving your form, our manager will get back to you within 24 hours with a 3-day trial plan & quotation

Email *

WHAT IS YOUR GOAL? *

Mild weight loss of 0.5 lb (0.25 kg) per week (RECOMMENDED)

Weight loss of 1 lb (0.5kg) per week

Extreme weight loss of 2 lb (1 kg) per week (NOT RECOMMENDED)

Maintain weight

Mild weight gain of 0.5 lb (0.25kg) per week (RECOMMENDED)

Weight gain of 1 lb (0.5kg) per week

Extreme weight gain of 2 lb (1kg) per week (NOT RECOMMENDED)

WHAT IS YOUR AGE? *

YOU ARE *

Male

Female

WHAT IS YOUR CURRENT HEIGHT (CM)? *

WHAT IS YOUR CURRENT WEIGHT (KG)? *

YOUR BODY FAT % IS *

~40%

~35%

~30%

~25%

~20%

~15%

Below 15%

DESCRIBE YOUR ACTIVITY LEVEL *

*exercise = 30-45 minutes / *intense exercise = above 45 minutes with challenging rest time

Basal Metabolic Rate (BMR, no exercise, sedentary job)

Light: exercise 1-3 times/week

Moderate: exercise 4-5 times/week

Active: daily exercise or intese exercise 3-4 times/week

Very Active: intense exercise 5 times / week

Super Active: intense exercise daily

SELECT THE TYPE OF TRAINING YOU'RE DOING *

None or Relaxed Activity

Lifting

Cardio

Cardio & Lifting

Other:

NUMBER OF DAYS PER WEEK *

*To achieve maximum result, diet should be followed at least 5 days a week

3 days

4 days

5 days

6 days

7 days

Other:

NUMBER OF MEALS PER DAY *

1 meals / day (cost vary from 150.000~200.000 vnđ / day, depends on amount of protein)

2 meals / day (cost vary from 300.000~400.000 vnđ / day, depends on amount of protein)

3 meals / day (cost vary from 450.000~600.000 vnđ / day, depends on amount of protein)

WITH JUICE INCLUDED *

*Body Impact special blend of fruit and vegetable are packed with vitamins and have tons of health benefit. Our juice will definitely boost your heath status to another level. NO sugar and preservative added.

Yes

SPECIAL NOTE FOR ALLERGY OR DIET RESTRICTION (EX: GLUTEN FREE, DAIRY FREE, NO NUTS, ETC...) *

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