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LIFESTYLE PLAN

Please complete the form below for your customized Lifestyle Plan!

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What is your...

Height
Weight (lbs)
Body Fat (%)
How many hours do you sleep per night?
Is your sleep inturrupted?
If so, do you know why?
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Physical Activity

What barriers do you face when it comes to getting physical activity?
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How much time could you commit to physical activivty?
What foods do you eat in your current diet?
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How many meals and/or snacks do you have per day?
Do you feel you eat healthy "most of the time”
What are your goals for starting this plan?
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How would you like your plan structured?
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