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Healthy habits personal information form
You are ready to make some changes to your lifestyle, good work, please answer all the questions as honestly as possible and hit submit. You must be able to use 'my fitness pal' which you will use as part of the healthy habits plan.

Once your information is submitted I will aim to get back to you within 48 hours with the next steps.
Email address *
Name *
Your answer
Age *
Your answer
Height (cm) *
Your answer
Weight (kg) *
Your answer
Measurements hips (inches) *
Your answer
Measurements waist (inches) *
Your answer
Measurements (inches) tummy *
Your answer
Activity levels *
Required
What is your primary goal of this healthy habits plan (you can include more than one) *
Your answer
Are you ready to be 100% honest in recording your daily food & liquid intake? (you will only achieve results this way) *
Required
DISCLAIMER & PRIVACY POLICY *
The healthy habits plan is a personalised framework that provides recommendations to assist you in creating good habits & empowers you in making more informed, better choices around eating & drinking. By signing 'yes' below, you are hereby agreeing that Antonia Ward (plan provider) cannot be held liable for any direct or indirect consequences arising from following your healthy habits plan. Should you have any medical conditions it would be advisable to get approval from your GP prior to starting your plan. Information collected from you will only be used for the purposes of providing you with a personalised healthy habits plan and for providing you with advice with regards to the healthy habits plan and will be in accordance with the General Data Protection Regulation GDPR May 28 2018. Your information will not be passed to any third parties. 
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