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Initial Questionnaire
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16
Questions
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1
Name
First Name
Last Name
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2
Phone Number
Area Code
Phone Number
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3
Email
example@example.com
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4
DOB
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Date
Year
Month
Day
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5
Height (cm)
CM
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6
Weight (kg)
KG
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7
How many times per week do you exercise?
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8
What is your occupation?
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9
What are your health and fitness goals?
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10
On a scale 1-10 how would you rate your knowledge of exercise?
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11
On a scale 1-10 how would you rate your knowledge of diet and nutrition?
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12
Are you, or have you used an app to track your calorie intake?
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13
How many meals per day do you currently eat, including snacks, and rough times?
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14
What is the biggest craving you have when trying to lose weight?
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15
Do you have a weekly food tradition?
Such as a quiz night, Saturday take away etc
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16
What changes to your diet have you already made, and been able to sustain?
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