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Health & Fitness Survey
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1.
What is your full name?
(Required.)
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2.
Contact Number
(Required.)
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3.
Are you happy with your current weight & health?
(Required.)
Yes
No
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4.
On a scale of 10, how would you rate your health and fitness?
(Required.)
1
2
3
4
5
6
7
8
9
10
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5.
Would you like to know more about leading a healthy lifestyle?
(Required.)
Yes, I would like to be contacted
No, Thanks