| Your Name |
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| Your Email Address |
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| Your Mailing Address |
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| Your Age |
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| Your Sex |
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| Your Height |
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| Your Weight |
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| What is your workout history? |
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| Please explain your health and injury history in detail. |
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| What is your favorite type of physical activity? |
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How many days a week will you work out?
(Your program will be designed for this number of days.)
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| How many meals per day do you eat? |
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| What is your average daily caloric intake? |
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| What are your 3 favorite meats? |
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| Are you willing to drink 1 protein shake daily? |
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| What are your 4 favorite fruits? |
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| What are your 4 favorite vegetables? |
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What are your 4 favorite complex carbohydrate sources?
(breads, oats, rice, starches, grains, etc)
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Do you have access to a gym or exercise equipment?
If so, please explain.
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Do you like to run, walk, cycle, or play any kind of sport?
If so, please explain.
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| Do you listen to music during your workout? |
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| Do you watch television during your workout? |
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Have you ever been a diet? If so please explain.
Did you accomplish your goal?
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| Do you feel good about your physical appearance? |
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| Do you suffer from depression or anxiety? |
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On a scale of 1-10 (1 being the lowest & 10 being the highest)
where would you rate your stress levels?
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| Do you drink Alcohol? If so how many drinks daily? |
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| Do you smoke or use Tobacco products? If so please explain. |
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| Do you believe you can acheive your health and fitness goals? |
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| Are you excited about your new lifestyle and Body By Davey T? |
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* These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
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