1. New Client Information

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* 1. Contact Information

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* 2. Are you a Health Hut or Java Hut Employee? 

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* 3. Best method of contact:

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* 4. Best Time of Day to Contact

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* 5. Date of Birth (MM/DD/YY)

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* 6. Age

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* 7. Current Weight (pounds)

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* 8. Weight (and/or Pant Size) 3 years ago

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* 9. Current Height (Feet-Inches)

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17% of survey complete.

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