Go In Raw! 30 Day Challenge
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Personal Information
Questionnaire/RSVP
First Time Going Raw/Plant Based?
*
Yes
No
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number (for sms updates)
*
-
Area Code
Phone Number
History and Current Status
Check the box that fits your current eating habits.
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Rows
Low
Moderate-High
Not At All
Bread
Fish/Shellfish
Eggs
Peanut or nut butter
Soy products
Milk
Nut oils
Cereal
Pasta
Take out
Canned meat
Frozen fruits
Frozen Foods
Frozen Veggies
Vegan
Veganish
Pescatarian
Fruitatarian
Vegetarian
Please enter all of the other foods that have caused an allergic reaction
What are your reasons for not being at your optimum health?
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Not Enough Time
Eating healthy is outside my budget
Not dedicated enough to do it
All of the above
Do you think a support system would help you stay on track? Why? ;
When do you plan to start your challenge?
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Month
-
Day
Year
Date
What Is your biggest obstacle?
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Working out
Shopping for healthy foods
Prepping recipes ahead (meal prep)
Other
How much time are you willing to spend a day on increasing your health?
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10-15 minutes
15-20 minutes
20-30 minutes
30-60 minutes
Whatever it takes
Whatever I feel like for the day
Additional notes you want to add
I commit to Go In Raw for 30 days to transform into a Doper version of myself! Signature
*
Let's Goooooo!
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