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HEALTH HISTORY FORM
Full Name and Age
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Email
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Phone Number
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Current Height and Weight
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Weight 6 months ago
What are your main concerns right now?
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Any secondary goals you'd like to address?
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At what point in your life did you feel your best? Please explain as fully as possible.
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How is your sleep? How much on average per night?
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Do you have pain, stiffness, or digestive discomfort? Please explain.
What are you cooking and craving?
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3 Day Diary Day 1: Meals (Ingredients, Calories, Macros)
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3 Day Diary Day 2: Meals (Ingredients, Calories, Macros)
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3 Day Diary Day 3: Meals (Ingredients, Calories, Macros)
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Anything else you'd like to share or comment about:
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