Sugar Reduction Plan Form
Share your current habits and set your goals to start your journey toward reduced sugar intake.
Full Name
First Name
Last Name
What motivates you to reduce your sugar intake?
*
How would you describe your current daily sugar intake?
*
Low (occasional sweets or sugary drinks)
Moderate (sweets or sugary drinks most days)
High (multiple sugary items every day)
Other
What are your main sources of added sugar?
*
Soft drinks
Juices
Candy or sweets
Baked goods
Breakfast cereals
Other
What is your main goal for reducing sugar?
*
Please Select
Lose weight
Improve energy
Better overall health
Reduce cravings
Other
Which strategies are you planning to try?
*
Replace sugary drinks with water or unsweetened beverages
Read nutrition labels for hidden sugars
Choose fresh fruits over desserts
Limit snacks with added sugar
Other
What challenges do you anticipate?
What is your target start date for your sugar reduction plan?
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Would you like to receive a follow-up or accountability check-in?
Yes
No
Additional notes or questions
Submit Plan
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