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  • Nutrition and Health Information Questionnaire 

    Pode responder em Portuguese
  • Personal Information

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  • Health Status

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  • Health Status

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  • Acknowledgment

  • I hereby certify that all information about my health condition and nutrition are accurate and true with the best of my knowledge. I understand that I am responsible for consulting my physician or health care provider about this nutrition consultation. I release this institution and its employees from any liabilities,claims, and demands that may arise during this consultation.

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