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RANCH TABLE CLUB

Nutrition & Wellness Intake Form

Pilot Program  •  Effective July 1, 2026  •  ranchtableclub.com

IMPORTANT DISCLOSURES — Please Read Before Continuing

 

This survey is for educational and nutritional planning purposes only. Ranch Table Club is NOT a medical provider and does not diagnose, treat, or manage any medical condition. Your responses help our Registered Dietitian and nutrition advisors tailor educational content and dietary guidance to your goals.

 

Completing this survey does not establish a patient-provider relationship and is not a clinical assessment or health screening. No diagnosis or treatment recommendation will be made based on survey responses alone.

 

No payment information is collected here. Subscription pricing will be provided separately, and no financial commitment is made until you confirm in writing.

 

FDA DISCLOSURE: These statements have not been evaluated by the Food and Drug Administration. Ranch Table Club products are not drugs and are not intended to diagnose, treat, cure, or prevent any disease.

 

By proceeding, you confirm you have read this disclosure and consent to the confidential collection of your health information for the purposes described above.

This survey takes approximately 5–8 minutes to complete. Your answers help us match you with the right protein box and ensure your consultation is focused on what matters most to you. Fields marked with * are required.

Section 1: About You

This is where we'll send your consultation summary and box recommendation.

Optional — used only for scheduling your consultation.

Biological Sex
Male
Female
Prefer not to say
Age Range
18-25
26-35
36-45
46-55
56-65
65 and older

Required for dietitian licensure and regulatory compliance.

Which best describes your household?
Single Adult
Couple, No Children
Family with Children at Home
Multigenerational Household
Other

Section 2: Your Diet

Which of the following best describes your current eating pattern?
Omnivore — I eat all food groups
Primarily meat focused / Animal-based
Ketogenic or very low Carbohydrate
Paleo
Flexitarian — mostly Plant-Based with Occasional Meat
Pescatarian — Fish and Plant-Based Only
No specific pattern — I eat what is available
Which animal proteins do you currently eat?
Do you have any food allergies or intolerances?
No
Unsure
Yes — Please describe:
On average, how many servings of animal protein do you eat per week?
0 — I don't currently eat animal protein
1–2 servings
3–5 servings
6 or more servings

A serving is roughly the size of your palm — about 3–4 oz.

Section 3: Health Background

This section helps our Registered Dietitian and nutrition advisors tailor your consultation. All responses are strictly confidential.

Do you currently have a primary care doctor or physician?
Yes
No
I see a specialist but not a primary care physician
Have you ever been diagnosed with any of the following? (Select all that apply)
Have you had bloodwork done in the past 12 months?
Yes, and I have the results available
Yes, but I don't have the results handy
No
I don't know

e.g., lipid panel, HbA1c, comprehensive metabolic panel. Sharing results is optional and used only to inform your dietary consultation — not for medical interpretation by RTC.

Are you currently taking any prescription medication on an ongoing basis?
Yes
No
Prefer not to say

No drug names are collected here. This helps us prepare relevant topics for your nutrition consultation.

Has a doctor or healthcare provider ever recommended specific dietary changes related to a health condition?
Yes
No

e.g., reduce sodium, lower saturated fat, avoid processed foods, or follow a specific therapeutic diet.

Which of the following best describes where you are right now?
Generally healthy — focused on optimizing performance or prevention
At risk — I've been told to address a condition and I'm taking steps
Managing a diagnosed condition, stable and under a doctor's care
Unsure — I'd like guidance on where I stand

Section 4: Your Goals

Which health and wellness goals matter most to you right now? (Select up to 3)
What is your primary reason for joining the Ranch Table Club Pilot? (Select up to 2)
How motivated are you to make dietary changes in the next 30 days?
Very motivated — I'm ready to start now
Motivated — I just need a clear plan
Somewhat motivated — I still have questions
Exploring — Not ready to commit yet

Section 5: Box Preferences

Your answers here shape the protein box our dietitian will recommend for you.

How many people will this subscription primarily feed?
1 person
2 people
3–4 people
5 or more people
How often do you cook at home?
Rarely
2–3 times per week
4–6 times per week
Daily
Which cuts or protein types are you most comfortable preparing? (Select all that apply)

Leave blank if not applicable.

Section 6: Getting Started

Optional — The more context you give, the more tailored your session will be.

How did you hear about Ranch Table Club?

Thank you for taking the time to complete this survey.

A member of the Ranch Table Club nutrition team will reach out within 2 business days to schedule your consultation. We look forward to serving you.

Privacy & Data Notice

 

The health information you provide is collected solely to facilitate educational nutrition consultation services. It is stored securely and accessed only by authorized RTC staff, our Registered Dietitian, and our Board-Certified Pathologist in an advisory capacity. Your information will never be sold or shared with third parties without your explicit written consent.


This survey does not establish a patient-provider relationship. All participants are encouraged to continue working with their primary care provider for all medical management needs.

 

These statements have not been evaluated by the Food and Drug Administration. Ranch Table Club products are not drugs and are not intended to diagnose, treat, cure, or prevent any disease.

 

© 2026 Ranch Table Club LLC  |  Sir Loin Meat Company LLC  |  Greenville, Texas  |  ranchtableclub.com

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