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Weight Management Profile

(Please print out and include in an e-mail)

Name:  _________________________________________________

Address:  ________________________________________________

E-mail:  __________________________________________________

Age: _____   Weight:  _____  General Health: ____________________

Food likes and dislikes: ______________________________________

__________________________________________________________

Lifestyle: (detail typical day) __________________________________

__________________________________________________________

__________________________________________________________

Present weekly menu: ________________________________________

__________________________________________________________

__________________________________________________________

__________________________________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________

Your weight management goals: ________________________________

___________________________________________________________

___________________________________________________________

Previous diet programs: _______________________________________

___________________________________________________________

 

       

 Fill out the information and copy and paste this profile which you can e-mail  by clicking on this icon.  Try to do this today, for a healthier approach to weight management.

    

 

 

 

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