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Health Survey
1
Name
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First Name
Last Name
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2
Age
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Ex:23
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3
What made you Gain / Lose Weight?
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Sedentary Lifestyle
Eating Habits
Post Pregnancy
Post Surgery
Post medication
Post illness
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4
Why do you want to Gain / Lose Weight now?
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Doctor advised
Job Requirement
Special Occasion (Ex: Wedding)
Want to take charge of my Health
Other
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5
How serious are you about weight loss and a body transformation right now?
I am seriously Interested and I want to start as soon as possible
I am Not very serious right now, I am just gathering information
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6
Current Weight
*
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7
Target Weight
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8
Height
*
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9
WhatsApp Number
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Please enter a valid phone number.
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10
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