Name *
Name
FOOD selections: Please eliminate and replace
Top 5 unhealthy foods (Please select 3 unhealthy foods to eliminate)
Top 5 healthy Food alternatives: (Please select 3 corresponding healthy alternatives to your 3 eliminated unhealthy foods)
ACTIVITY selections: 30 Minutes physically active
Please select 4-5 days the you’ll keep active
BEVERAGE selections: Please eliminate and replace
Top 5 unhealthy beverages (Please select 3 unhealthy beverages to eliminate)
Top 5 healthy beverages (Please select 3 corresponding healthy alternatives to your 3 eliminated Beverages)