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1
HEALTHIER - FITTER - SLIMMER
WITH
THE NEW WAY TO YOUR
IDEAL BODY WEIGHT
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2
Please tell me your first name so that I can speak to you personally. You already know mine
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3
Your age range
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Under 25
25-40
40-50
50-60
60+
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4
How many kilos would you like to lose?
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under 3 kilos
3-7 kilos
8-15 kilos
16-25 kilos
26-35 kilos
more than 36 kilos
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5
What motivates you most to reach your nutritional goals?
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Select as many as necessary
Improve my health
Improve my appearance
Have more energy
To feel good in my own skin
To fit into my old jeans
Something else
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6
How would you rate your current health?
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Excellent
Very good
Good
Average
Bad
Very Bad
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7
How often do you work out?
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7 days per week
3-5 days per week
Sometimes
Never
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8
Which food groups do you love the most
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Select as many as you like
Fruit
Vegetables
Protein ( meat, fish eggs)
Carbs ( bread, rice, pasta)
Sweets and snacks
All
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9
Do you have food allergies or intolerances?
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YES
NO
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10
What is your favourite foods?
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11
What is your profession?
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12
How strong is your desire to reach your feel-good weight?
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1
2
3
4
5
6
7
8
9
10
Not that strong
Very strong
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13
What is currently holding you back from reaching your weight loss goals?
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Select as many as necessary
Lack of time
Lack of knowledge & understanding
Lack of motivation
Unhealthy habits
Health problems
My environment
Other
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14
Please add your contact details so we can get to know each other and I can tell you more about the concept?
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Please enter your email
Please enter your phone number, including country code
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