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Healthier - Fitter - Slimmer with the new way to your ideal body weight
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1
Please tell me your first name so I can speak to your personally
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You already know mine*
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2
Your age range?
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under 25
25-40
40-50
50-60
60+
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3
What motivates you most to achieve your 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
Be able te wear my favorite jeans again
Something else
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4
If you want to lose weight, how many kilos would you like to lose?
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max 3 kilos
3-7 kilos
8-15 kilos
more than 15 kilos
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5
How would you rate your current health?
*
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Excellent
Good
Average
Bad
Very bad
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6
How often do you work-out?
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7 times a week
3-5 times a week
2 times a week
sometime
never
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7
Wich food groups do you love most?
*
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Select as many as you like
fruit
vegetables
proteïn (meat, fish, eggs etc)
carbs
sweets & snacks
all
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8
Do you have food allergies or intolerances
*
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JA
NEE
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9
What is your favorite meal?
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10
What do you do in your daily life?
This helps me get an idea of your daily activities besides sports.
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11
How strong is your desire to reach your feel-good weight?
*
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1
2
3
4
5
niet heel gemotiveerd
super gemotiveerd
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12
What is currently holding you back from reaching your weightloss goals?
Select as many as necessary
Lack of time
Lack of knowledge & understanding
Lack of motivation
Unhealthy habits
Health issues
My environment
Other
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13
We are almost there! ! I'll contact you so we can get to know each other better and I can tell you more information about my concept
*
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I take privacy seriously, I only use your information to contact you about Reshape program
voorbeeld@voorbeeld.com
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14
Do you prefer me to contact you via Whatsapp, please leave your 06 number
Netnummer
Telefoonnummer
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