Client Information

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* 1. Contact Information

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* 2. Best method of contact:

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* 3. Best Time of Day to Contact

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

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* 5. Age

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* 6. Current Weight (pounds)

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

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* 8. Current Height (Feet-Inches)

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* 9. Best Time of Day for Appointments (in-person, phone or video chat)

  Morning (9:00am-11:30am) Afternoon (12:00pm-4:00pm) Evening (5:30pm-8:00pm)
Monday
Tuesday
Wednesday
Thursday
Friday

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* 10. What is your preferred program type? (Check all that apply)

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