First Name:

Last Name:

Birth Date:

Gender:

Ethnicity:

Phone:

Email Address (this will be your login, and where the web site will send confirmation of your food orders):

Confirm Email Address:

Street Address:

City:

State:

ZIP Code:

Body Weight:

Have you had your body fat measured? If so, what was the percentage and how was it measured?

Do you have heart problems of any type? If so, please describe:

Do you have a family history of heart problems? If so, please describe:

Do you have high blood pressure? If so, what is the systolic/diastolic value?

What is your blood type?

Have you had blood work done as part of a recent physical? If yes, was anything abnormal?

Do you know your total cholesterol? If so, do you know the breakdown of HDL and LDL?

Are you lactose intolerant or allergic to dairy products?

Are you diabetic or “pre-diabetic” (as diagnosed by a doctor)?

Do you have a family history of diabetes? If so, from which side of your family?

Do you have any food allergies? If so, was this diagnosed by a blood test or by cause-and-effect?

Are you taking any medications? If yes, please list:

Are you pregnant or do you plan on becoming pregnant soon?

Do you have any signs of arthritis? If so, describe:

Do you have any injuries? If so, please describe, including how long ago you were injured:

Have you ever had gout? If so, how long ago?

Have you ever had cancer? If so, please describe:

Do you have a family history of cancer? If so, please describe:

Do you have osteoporosis? If so, where and how severe is it?

Does anyone in your family have osteoporosis? If so, what is their relationship to you?

Do you frequently have dry eyes? If yes, have you noticed a correlation regarding what causes it?

Are there any other medical conditions you can think of that would affect your diet?

In the last 2 years, has your weight changed? If so, how many pounds up/down?

Compared to other people that are about the same size/age as you, do you feel that you can eat more than them, the same, or less than them AND maintain your weight?

Rate your daily stress level on a scale of 1 to 5 (5 being highest):

Rate your typical energy level on a scale of 1 to 5 (5 being highest):

How many times per day do you typically eat, including snacks?

Give an example of a typical day’s meals and snacks:

Do you have “favorite foods” that you find you eat all the time? If so, please list them:

What is your resting heart rate in beats per minute? Please measure while relaxed:

Do you do cardiovascular exercise? If so, what type, how often, how long, and what is your typical heart rate while exercising?

Do you lift weights? If so, how many days per week? Describe your current routine (sets, reps, etc.):

If you lift weights, describe how much effort you put in on a scale of 1 to 5 (5 being hardest):

If you lift weights, how long have you been on your current routine? Are you changing it soon?

Do you stretch? If so, before or after exercise (or both)? How much time does your routine take?

Do you compete in any sport(s)? If so, is there an event that you’re peaking for, and when is it?

Do you have a specific body weight or body fat goal? If so, describe in detail:

Do you have a specific health goal? If so, describe in detail:

Do you have a specific performance goal? If so, describe in detail:

Do you have any other goals that you'd like to achieve through your diet?

How many meals would you like delivered per day? Breakfasts, snacks, lunches, and dinners are priced as follows:
3 meals/delivery - $17/meal
4 meals/delivery - $16/meal
5 meals/delivery - $15/meal

How many TOTAL meals will you be eating per day (including meals you make - we will later refer to the meals you prepare as "non-PFW meals")?

Are there any days of the week that you would like to skip delivery?

Are there any delivery considerations that must be taken into account (meals shipped to a specific location, several days of meals delivered at a time, etc)?

Are there any meats that you do NOT like? Please list:

Are there any vegetables that you do not like? Please list:

Are there any fruits that you do not like? Please list:

Please list any foods you do not like that may not fall into one of these categories:

Are you taking any supplements? If so, please list:

How salty do you like your meals? Rate yourself on a scale of 1 to 5 (5 being highest):

Do you like pepper? Rate yourself on a scale of 1 to 5 (5 being highest):

How spicy do you like your meals? Rate yourself on a scale of 1 to 5 (5 being highest):

Do you like chocolate? Rate yourself on a scale of 1 to 5 (5 being highest):

Do you have sweet tooth? Rate yourself on a scale of 1 to 5 (5 being highest):

Do you like garlic? Rate yourself on a scale of 1 to 5 (5 being highest):

Are there any spices you do NOT like? If so, please list:

Do you have somewhere to heat your meals during the day?

All Precision Food Works (PFW) meals are prepared specific to each individual and are not served in family portions that can be divided. The meals are delivered in recyclable, microwave-safe plastic containers. These containers should ONLY be used to heat meals in a microwave. They will melt and/or catch fire if placed in a convection or conventional oven. Please check the contents of the container, as some meals are wrapped in plastic wrap to retain moisture. This must be removed before reheating. The chefs will do their best to spice the meals as requested. Please do not add ketchup, mustard, salsa, extra cheese, or any additional sauces to the meals. The additional calories can throw off the macronutrient ratios, as well as the sodium content. Hydration is considered to be the responsibilty of the client and water/fluids are not provided by PFW.

Menu changes may be made through the web site. Cancellations, skipped meals, skipped days, meal selections, meal ratings, etc., are logged, and the chefs will follow the instructions provided in the Notes to Chef box. All phone, email, or text messages regarding meal cancelations must be received before 9pm PST the day before the meal is prepared. The web site will allow changes to take place until 4 am on the day the meal is prepared.

The meal pricing structure breaks down as follows:
5 meals/day: $15/meal + tax
4 meals/day: $16/meal + tax
3 meals/day: $17/meal + tax

There is no delivery charge on meals delivered in Los Angeles county.

Meals shipped outside of California will not be charged sales tax. Shipped meals will be priced as above, with the addition of overnight shipping fees (charged at the same rate that Fedex, USPS, or UPS charges PFW), as well as a $20/shipment packaging fee. This packaging fee covers the shipping container, styrofoam cooler, dry ice, and vacuum sealing of the meals. FedEx, USPS, and/or UPS hold all responsibility for keeping PFW shipping packages (containing dry ice and labeled as perishable) in a suitable environment during transportation. Any claim for spoiled meals will need to be directed toward the shipping company and is not the responsiblity of PFW.

For all Los Angeles county meal services, delivery will take place the evening before the meals are to be eaten. Delivery is considered to have taken place when the meals are left on-site, whether or not they are handed to the client. Though effort will be made to hand the meal delivery directly to the customer, interfering factors must be considered. A meal delivery will be considered to have taken place if meals are received, on behalf of the client, by front-desk employees, security guards, location-specific personnel, partners, co-workers, or anyone previously discussed as having authority to receive the meals on your behalf. A meal delivery will also be considered complete if meals are placed in a cooler and left outside the home in a location previously discussed with the tenant.

Payment can be made by check, cash, or credit card. There will be a 10% late fee on all invoices 60 days past due. Invoices open past 90 days will incur an additional 1.5% per month penalty.