Applying For:
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Which plan are you interested in?
Name
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First Name
Last Name
Email
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Phone number
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(###)
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Current age?
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Current height in feet & inches?
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Current weight in pounds?
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Goal weight in pounds?
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Do you have a deadline for your goal?
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If so, when is it?
Lowest weight in the last 5 years:
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Highest weight in the last 5 years:
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What do you do for work?
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How labor intensive is your job?
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How many hours do you work per week?
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Do you workout regularly?
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If so, how often, for how long, and what type or workouts?
If not, are you willing to start?
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How much water do you drink per day?
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Are you CURRENTLY following a specialty diet (check all that apply):
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Describe your current eating habits:
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Do you drink:
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Do you:
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If you answered yes above, please elaborate:
Do you have experience tracking macros?
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Do you prep your meals?
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Have you used dieting methods in the past (Weight Watchers, Nutrisystem, etc)?
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If you answered yes, please elaborate:
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What are your favorite foods?
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What are your least favorite foods?
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If you have food allergies, please list them here:
Do you take vitamins or supplements?
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If you answered yes above, please elaborate:
If there is anything else you think I should know, please add that here:
