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* 1. Required Contact Information

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* 2. Do you relate to any of the negative conditioning and habits described? Explain.

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* 3. What are results of not eating healthily?

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* 4. What are some results of harmful stress?

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* 5. What are some results of not exercising?

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* 6. What are some results of sleep deprivation?

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* 7. What are some results of dehydration?

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* 8. What are some results of toxicity?

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* 9. What are some benefits you are looking to obtain from the FTW Program you are currently in? And what actions are you committing to make for those benefits happen?

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* 10. Where do you fall, in your current life habits, on the scale of success?

0 Only follow negative habits 5 Mixture of negative and successful habits 10 Only follow successful habits
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i We adjusted the number you entered based on the slider’s scale.

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