Njawatech Solutions

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If you are looking to lose weight, then a weight loss consultation might be appropriate for you

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Diet Plan Questionnaire Form

Your Name

Personal Details

1.

Your Mobile Number

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2.

Your Gender

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3.

Your Age

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4.

Your Weight

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5.

Your Email Address

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6.

How many meals do you take Per Day on Average

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7.

What do u take for BreakFast

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8.

What time do you take your breakfast

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9.

What do u take for Lunch

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10.

What time do you take your Lunch

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11.

What do u take for Dinner

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12.

What time do you take your Dinner

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13.

How Often do take Junk Per Week

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14.

How Often Do u take Soft Drinks Per Week

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15.

Are you Allergic to any Foods..Kindly List them Below

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16.

What did you take on Monday.Fill in the Spaces Provided
(Breakfast,Lunch,Supper)

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17.

What did you take on Tuesday.Fill in the Spaces Provided
(Breakfast,Lunch,Supper)

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18.

What did you take on Wednesday.Fill in the Spaces Provided
(Breakfast,Lunch,Supper)

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19.

What did you take on Thursday.Fill in the Spaces Provided
(Breakfast,Lunch,Supper)

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20.

What did you take on Friday.Fill in the Spaces Provided
(Breakfast,Lunch,Supper)

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21.

Do You WorkOut

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22.

What Kind of Workout

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Workout Schedule

23.

Monday WorkOut

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24.

Tuesday Workout

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25.

Wednesday Workout

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26.

Thursday Workout

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27.

Friday WorkOut

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