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* 1. Please select all that apply:

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* 2. What are your health and fitness goals, short and long term?

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* 3. How you eat can be just as important as what you eat. Please tell me where you were and how you were feeling during your meal times yesterday.

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* 4. How many times a day do you eat? (Meals and snacks)

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* 5. Rate your current stress level :

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* 6. Rate your current sleep quality:

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* 7. Daily water intake?

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