Fit OrganiX home beaclient ProudFM
email: info@fitorganix.com,  tel: (647) 478-7875
Once you complete the following questionnaire we will email you a sample menu plan to review. We can arrange for a phone conversation to answer any additional questions you might have.


THE ESSENTIALS

First name
Last name
E-Mail
Daytime Telephone
Alt. Telephone
Address
Address2
Major Intersection
CityToronto (GTA)
ProvinceOntario
Postal Code
Delivery Notes

The section is not mandatory, but it will help us help you!

Gendermale female
Birthday
Height (ie 5' 6" or 5 feet 6 inches)
Weight pounds
Waist inches (at the navel)
Hips inches (at the hip bone)
Wrist inches (circumference)
 
Exercise: cardio hour(s) per week
Exercise:weights hour(s) per week
Exercise: classes hour(s) per week
Exercise:stretching hour(s) per week
Exercise: yoga hour(s) per week
Exercise: other hour(s) per week  
 
MotivationConvenience Wellness Weight loss

Previous Diet Programs
Current Medications, supplements, vitamins: please list all + dosages if possible.
Medical History/Concerns
Allergies (food of otherwise)
Current personal goals-fitness related or otherwise

MENU PLAN

Please select a food program which you think might best suit your tastes and fits your dietary goals. Do not be too concerned if some of the terms seem unfamiliar or if you are uncertain as to which might be the best fit, we will review them with you and make recommendations when we cusomize your menu. This is a starting point only.

Regular Fit OrganiX Plan (lean organic proteins, antioxidant and superfood combinations, healthy fats, small amounts of grains)
Paleo-like Fit OrganiX Diet (lean organic proteins, no dairy, no grains, no soy, high antioxidant and super foods, healthy fats)
Vegan Fit OrganiX Diet (plant based proteins, no wheat, no dairy, high in antioxidant and super foods, healthy fats)

Anticipated Start Date
Best time to callmorning afternoon evening

I do not have any life threatening allergies.
I understand that I should consult my physician before starting any meal program.
I understand that I should consult my pharmacist, if applicable.

How did you hear about us?



Name of referrer



DISCLAIMER

This program is not intended to replace medical advice. If you are under the care of a physician and/or take medications for diabetes, heart disease or hypertension, consult with your health care provider prior to initiation of this or any dietary program. Implementation of this dietary program may require alteration in your medication needs and must be done by or under the direction of your physician.

Let's Talk!