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Personal Profile (AFTER)
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1.
Full name
(Required.)
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2.
Email
(Required.)
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3.
My current cooking level is:
(Required.)
Absolute beginner
Beginner - Level 1
Intermediate or higher
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4.
My current cooking frequency is:
(Required.)
Less than 25% of all meals
25%-50% of all meals
50%-75% of all meals
75% or more of all meals
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5.
My current daily diet is:
(Required.)
Diet is 25% or less whole food ingredients
Diet is 25% - 50% whole food ingredients
Diet is 50% - 75% whole food ingredients
Diet is 75% or more whole food ingredients
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6.
My current body confidence and relationship with food is:
(Required.)
Very poor
Poor
Fine
Good
Excellent
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7.
Please select the option that best describes you:
(Required.)
I had success in losing some weight through the Homemade Program
I did not have success in losing any weight through the Homemade Program
I am not sure
I am not trying to lose weight
8.
If you lost any weight through the Homemade Cooking Program, please enter it here in pounds:
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9.
To achieve my ideal weight, I would still like to lose:
(Required.)
5-9lbs
10-24lbs
25-40lbs
More than 40lbs
I am not trying to lose weight
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10.
Did you experience improvements with any health issues (tick all that apply):
(Required.)
I did not have any health issues when the Program started
Diabetes or Pre-diabetes
High blood cholesterol
High blood pressure
Heart disease
Menopausal changes
Food allergies or digestive issues
I'm not sure
I have results and they show no improvements
Other (please specify)
11.
If you experienced improvements with any health issues, please specify here and enter your current blood numbers here, if known (blood sugars, cholesterol, pressure)
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12.
Did you experience any other improvements (skin, sleep, energy, moods, digestion, allergies, etc)?
(Required.)
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13.
Did you achieve your goals through the Homemade Program? Please explain
(Required.)
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14.
On a scale of 0 to 10,
How likely is it that you would recommend Life-Changing Cooking to a friend or colleague?
0 for Not at all likely, 10 for Extremely likely
(Required.)
Not at all likely
Extremely likely
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15.
We would be delighted if you could provide us with a testimonial here!
16.
Do you have any suggestions or feedback on ways we could improve the program?