AGF – Signup Sign Up You are now only a step away from achieving your health goals and getting the body that you have always wanted. It should take no more than 5 minutes to complete this form. Personal DetailsYou are minutes away from delegating all the hard work, we look forward to taking care of you. Are you a returning customer? If you are you do not need to go through the form again unless you want to change your food or delivery preferences. If you would like to change your delivery address, food preferences or delivery dates, please note that this will be on new orders only. If you wish to change anything on a current order please call one of our Client Services team on: 08456 123 888 or email email@example.com and we will be happy to assist you.Name* First Last Username*Password* Enter Password Confirm Password Strength indicator Post Code*Please select...Not in this listBR1BR2BR3BR4BR5BR6BR7BR8CR0CR2CR3CR4CR5CR6CR7CR8DA1DA14DA15DA16DA17DA18DA2DA5DA6DA7DA8E1E10E11E12E13E14E15E16E17E18E2E3E4E5E6E7E8E9EC1EC1REC1VEC2EC2VEC3EC4EC50EN1EN2EN3EN4EN5GU25HA0HA1HA2HA3HA4HA5HA6HA7HA8HA9IG1IG10IG11IG2IG3IG4IG5IG6IG7IG8IG9KT1KT10KT11KT12KT13KT14KT15KT16KT17KT18KT19KT2KT20KT21KT22KT26KT3KT4KT5KT6KT7KT8KT9N1N10N11N12N13N14N15N16N17N18N19N2N20N21N22N3N4N5N6N7N8N9NW1NW10NW11NW2NW3NW4NW5NW6NW7NW8NW9RM1RM10RM11RM12RM13RM19RM2RM4RM5RM6RM7RM8RM9SE1SE10SE11SE12SE13SE14SE15SE16SE17SE18SE19SE1PSE2SE20SE21SE22SE23SE24SE25SE26SE27SE28SE3SE4SE5SE6SE7SE8SE9SL4SL5SM1SM2SM3SM4SM5SM6SM7SW1SW10SW11SW12SW13SW14SW15SW16SW17SW18SW19SW1ASW1ESW1HSW1PSW1VSW1WSW1XSW1YSW2SW20SW3SW4SW5SW6SW7SW8SW9SW95SW99TN16TW1TW10TW11TW12TW13TW14TW15TW16TW17TW18TW19TW2TW20TW3TW4TW5TW6TW7TW8TW9UB1UB10UB11UB18UB2UB3UB4UB5UB6UB7UB8UB9W1W10W11W12W13W14W1AW1BW1CW1DW1FW1GW1HW1JW1KW1SW1TW1UW1WW2W3W4W5W6W7W8W9WC1WC1RWC1XWC2WC2HWD17WD18WD19WD23WD24WD25WD3WD5WD6WD7Other Post Code*If your post code is not in the list, unfortunately we do not deliver to your area. Please get in touch using the above number or email to discuss your interest.How did you find us?Where did you hear about us?*Select one...Flyer through letterboxFriend/RelativeGoody BagGoogle SearchGymHoliday CompanyNewsletterPersonal TrainerPressTherapistYahoo SearchName of client?*Which search engine?*Which publication?*Where was the advert?*Enter Promotional Code*Please specify*Please specify*Please specify*Programme DetailsWhat are your main goals with starting a programme with The Pure Package?* Weight Loss Health Training Support Pregnancy Mum & Baby Skin Mental Performance Detox Congratulations! What is your baby’s date of birth?*Are you breast feeding?*YesNoCongratulations! What is your due date?*Relevant Medical ConditionsDo you suffer from any relevant medical conditions?*YesNoPlease specify*Unfortunately we do not currently accept insulin dependent diabetics.Severe Food AllergiesDo any food groups cause you anaphylactic shock?*YesNoPlease call us to discuss on 0845 6 123 888Personal InformationGender*FemaleMaleDate of Birth* We currently only accept those over 18 years. If you are under 18, please call our team on 08456 123 888.Height*Heights Units*Metres / centimetersFeet / inchesCurrent Weight*Current Weight Units*KGStone / poundsGoal Weight*Goal Weight Units*KGStone / poundsFood and DrinkFood Diary Please give us some details of your daily or weekly food intake so we can cater your plan closer to your needs.How much do you drink?We recommend 1.5 to 2 litres of water per day.Do you drink alcoholNoYesWhat alcohol do you drink, how often and how much?Do you drink caffeinated drinks?NoYesWhat caffeinated drinks do you drink, how often and how much?ExerciseExercise Frequency*Exercise dailyExercise 3–5 times per weekExercise 1–3 times per weekRarely exerciseUnable to exerciseWe recommend raising your heart beat for an average of 30 minutes a day.What type of exercise do you do?*Work and StressOn a scale on 1–10 how stressed would you say you are?Please select...1234567891010 being the most stressedOccupation?Delivery InformationPlease indicate which days you would like delivery. You can change your delivery schedule by calling or emailing us and simply giving us three full working days' notice. Delivery Schedule* Monday Friday Tuesday Saturday Wednesday Sunday Thursday Start Date* If you would like to start sooner than the date picker allows, please continue with your sign up and then call us. We may be able to start you soonerDelivery Instructions*Please select...Front doorBack doorSide doorUse Key (we will contact you to organise)Leave with 24hr securityOtherIf other, please specify*Additional Delivery InstructionsDelivery Address* Street Address Address Line 2 City ZIP / Postal Code Billing Address Click here if your billing address is the same as your delivery address These addresses will be used as default for all future ordersBilling Address* Same as Delivery Address Street Address Address Line 2 City ZIP / Postal Code Contact DetailsMobile Phone*Other PhoneEmail* Enter Email Confirm Email Contact Preference*EmailMobile PhoneOther PhoneFood PreferencesFood preferencesI want to try everythingI want to pick & choose the ingredients that I don't likeFood ExclusionsPlease check the box next to any of the ingredients below that you don't wish to receive. If there is an ingredient that particularly concerns you, please contact us by telephone or email. We do not use: Pork, Offal or Wheat (we replace it with rye, barley, oats, polenta, spelt and rice). You can select up to 3 food exclusions without any additional charge. For 4–9 food exclusions, an extra £5 per day is charged. 10+ food exclusions, you will be signed up for our personal chef programme. Please call for details. Our vegetarian programme counts as 1 food exclusion. Our vegan programme counts as 2 food exclusions. Please select how many exclusions you require from the drop down menu1-3 food preferences (Free)4-9 food preferences +£5.00 per day10 or more food preferences £60.00 per day*Special Requirements Vegetarian All Meat Red Meat All Dairy Vegan All Seafood All Cheese Lactose Red Meat Beef Lamb Duck Ostrich Venison Other Meat Chicken Smoked Meat Seafood Smoked fish White fish Oily fish Shellfish Dairy Yoghurt Dairy Cheeses Parmesan Cream Cheese Cottage Cheese Ricotta Non-Dairy Cheeses Feta Cheese Goat's Cheese Halloumi Mozzarella Fruit & Vegetables Onions Garlic Tomato Raw Tomato Sundried Tomato Mushrooms Peppers Aubergine Courgette Potatoes Coriander Chilli Banana Kiwi Citrus Eggs Eggs Eggs (visible) Misc Soya / Tofu Beans / Pulses Seeds Nuts Pine Kernels Sugar Yeast Gluten First Choice DetailSecond Choice DetailThird Choice DetailIf any of the ingredients you've ticked are an allergy or intolerance, please provide details hereYou have currently selected fewer than four food exclusions. There is no additional charge. You have currently selected fewer than four food exclusions. There is no additional charge. We exclude honey, alcohol, vinegar, mushrooms and bread. Yeast is rich in B vitamins which can help to relieve stress. Beans are a good source of fibre and a good low fat source of protein. We count lentils, chickpeas, butter/cannelenni/kidney etc beans and falaphel in this category. If you are happy having eggs in our healthy cakes, muffins and chocolate mousses but don’t like actual egg dishes please tick here. We will ensure you receive a healthy balanced diet while excluding all meat & fish products. We will ensure you receive a healthy balanced diet while excluding all animal products. All meats are a good source of protein. We only use free range / organic meats. We only use lean red meat. A good source of protein and iron which can help increase energy levels. Smoking meats adds flavour We only use lean cuts. Rich in vitamin B12, which promotes cardiovascular health. We only use lean cuts. High in zinc improving immune function and helps stabilises blood sugar levels. Duck contains vitamin A important for maintaining good eyesight. We make sure your not getting the fatty bits. Contains less fat and more protein than beef, and is similarly a good source of iron to boost energy levels. We only use free-range. A lean protein source in your diet can prevent longterm bone health. We only use free-range. A good source of selenium, which helps to maintain a higher metabolism. Seafood is a good source of zinc vital for our immune system and can help improve skin condition. We use easy to eat seafood Smoking adds to the flavour White fish provide us with vitamins B6 and B12 to help lower high cholesterol levels. We use easy to eat white fish Oily fish is rich in omega 3 essential fats which are vital for good skin condition and optimal brain function. We use easy to eat oily fish Shellfish contains magnesium important for muscle relaxation and digestion We mean cows milk products only and will replace it with sheeps, goats, buffalo & soya products. Live natural yoghurt improves digestion by helping to replenish supplies of healthy gut bacteria. The calcium and vitamin D found in cheese can help to strengthen our bones. Feta cheese contains riboflavin, a B vitamin important in energy production. Goats cheese is often higher in protein and lower in fat than cheese from cow’s milk A good source of phosphorus which is vital for collagen production - keeping our skin and bones supple. Cream cheese is a better source of vitamin D than the more low fat dairy products. Vitamin D aids the absorption of calcium. Cottage cheese is a high quality protein with benefits of Vitamin B2; Riboflavin, which activates the efficiency of other B vitamins. B vitamins boost energy levels and help us to cope with stress. Halloumi is made of a combination of sheep and goat's milk with a distinct, yet light flavour. Ricotta cheese is made from whey - a protein source regularly used in sports training. Whey has many essential amino acids which are the building blocks for healthy muscles. We only use Buffalo mozzarella, a rich source of calcium to help strengthen bones. We only use cooked onions which may help to lower blood cholesterol levels We only use cooked garlic. Rich in the antioxidant, allicin, which can aid cardiovascular health. Contains antioxidant lycopene, Vitamin A &C. Contains antioxidant lycopene, Vitamin A &C. The antioxidant lycopene is best absorbed from 'cooked' tomatoes Can help support our immune system with virus and bacteria fighting antioxidants. A good source of vitamin A, well known for promoting healthy lungs. We do not use green peppers A good source of phytonutrients that protects cell membranes Containing about 95% water, courgettes are low in calories but surprisingly high in minerals, vitamins, fibre, potassium and folates. We only use sweet and baby potatoes. Baby potatoes have a lower Glycaemic Index (GI) than regular potatoes. Recognised as having anti-diabetic and cholesterol lowering properties. We only lightly spice our dishes. Chilli contains capsaicin which can reduce inflammatory conditions. Bananas are rich in potassium which is important for the functioning of cells, nerves and muscles. Kiwi fruit is extremely rich in vitamin C which helps boost the immune system Citrus fruit are good sources of antioxdiants vitamin C and beta carotene We only use free-range. Eggs contains lecithin which aids the breakdown of dietary fats and improves cholesterol levels. A source of choline, essential in production of the brain chemical, acetyl choline. This includes tofu which contain phytoestrogens which can help block damaging toxins in our environment. We only use organic & GM free Soya/Tofu Beans are a good source of fibre and a good low fat source of protein. We count lentils, chickpeas, butter/cannelenni/kidney etc beans and falaphel in this category. Raw seeds are rich in omega 3 & 6 essential fats which can help to reduce inflammation Raw nuts contain vitamin E, an important antioxidant helping to improve skin conditions Rich in potassium which helps maintain fluid levels and electrolyte balances in the body. We do not use any. We replace it with rye, barley, oats, polenta, spelt and rice. A protein found in wheat, rye, barley and oats. We replace it with polenta, quinoa, spelt and rice. We use only naturally-occurring sugars such as honey and fructose, which release energy at a slower, more stable rate. We will exclude all animal milk products and replace them with vegetable sources such as soya/tofu and rice. We use wild venison from local Cotswold estates. Venison is a lean meat, rich in iron with fewer calories than chicken. Terms and ConditionsTerms and Conditions* I agree You must agree to The Pure Package's Terms and Conditions before submitting this form.CommentsThis field is for validation purposes and should be left unchanged.