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Group Nutrition Application
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11
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1
Name
*
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First Name
Last Name
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2
Email
*
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example@example.com
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3
What are your nutrition goals? / What do you hope to get out of this program?
*
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4
Are you looking for a quick fix?
*
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YES
NO
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5
Do you want to learn more about nutrition and how to be healthier?
*
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YES
NO
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6
Have you tried and failed at dieting in the past?
*
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YES
NO
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7
Would you like to connect and collaborate with others to shares struggles/successes and hold each other accountable?
*
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YES
NO
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8
On a scale of 1-10 how motivated are you to learn about nutrition and/or change your habits?
*
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9
Are you a bride-to-be?
*
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YES
NO
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10
Do you have availability to participate in a virtual group setting for one hour per week? (likely M-F in the evening after 6PM)
*
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YES
NO
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11
Is there anything else you think we should know?
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