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Contact
Home
Travel
Health Advocate
Food
Products
About
Contact
Name
*
First Name
Last Name
Email
*
DOB
Where do you currently live?
Current height and weight
*
Do you wish to:
Gain weight?
Lose weight?
Maintain?
Reason for wanting coaching?
Occupation/how many hours per week do you work?
*
Do you enjoy your work?
Current health problems?
Preferred days and times for appointments?
How do you manage stress?
Do you smoke?
How many hours do you work per day? Sleep per day?
What do you do for exercise?
Relationship status:
If applicable, how much time do you spend with them? How much uninterrupted quality time do you spend together? What activities do you enjoy doing together?
What do you do for "self care"?
Favorite hobbies?
Thank you!
