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Intake form
This is the beginning of your complete transformation.
Please complete this form as honestly as possible.
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Name
*
First
Last
Date of Birth
*
Weight
*
Height
*
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Lightest weight in the past year
*
Weight at 21 years old
*
Weight at 16 years old
*
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How many times a day do you eat?
*
What time do you go to sleep?
*
What time do you wake up?
*
How often do you workout/ exercise per week?
*
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What kind of work do you do?
*
How many hours do you spend working?
*
Do you have any physical injuries or dispositions?
*
Do you have any specific dietary restrictions?
*
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What are your physical and mental goals ?
*
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