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INITIATION QUESTIONNAIRE
OBJECTIVES
Primary Nutritional and Training Goals:
Fat loss
Muscle Gain
Clinical Objectives
Sports Performance
Other
Secondary Goals (if any):
Do you have any medical conditions?
Yes
No
If yes, please specify.
Do you have a family history of any medical conditions?
Yes
No
If yes, please specify.
Personal Medical History
anxiety
depression
eating disorders
past illnesses
Other
Do you have any food allergies or intolerances?
Yes
No
If yes, please specify
Include a frontal, lateral, and rear photograph.
Send
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