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Health Questionnaire
This form is to get insight on your goals and how to help you reach them effectively. Be able to reach your goals, maintain and keep your results and a healthy lifestyle.

*DO NOT FILL OUT FORM IF YOU ARE NOT SERIOUS ABOUT GETTING STARTED AND CREATING A NEW HEALTHY LIFESTYLE*
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Full Name *
Phone Number *
Social Media *
Email Address *
Age/Weight/Height *
What did you have for breakfast yesterday? *
How many times did you eat yesterday? *
How often do you eat out? *
How much money are you spending on food each week? *
What are all of your health and body goals? And why? *
Are you taking any supplements currently? *
Taking any meds? *
Do you drink coffee? *
Are you interested in earning extra income part time from sharing your journey and teaching your goals? *
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