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Nutrition Dr.
Nutrition Dr.
Full name
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First
Last
Contact number
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Email address
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Studio location
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Wellington CBD
Your primary goals
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Weight Management
Fat loss
Toning
Muscle Size Increase
Cellulite Reduction
Performance Increase (Athletes)
Rate your body shape
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1 = Poor / 10 = Excellent
Rate your fitness
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1 = Extremely Unfit / 10 = Extremely Fit
Daily stress levels
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1 = No Stress / 10 = Highly Stressed
Hours of sleep per night
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Please list any/all diagnosed diseases, allergies & chronic medication
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Do you use any vitamins/supplements?
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Do you experience any cravings?
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Dietary specifications
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Additional notes
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