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First Name
Last Name
Email
Phone
Country of Residence
Country
Age
Gender
Male
Female
Height (cm)
Weight (kg)
Workout per week
Sedentary: little or no exercise
Light: exercise 1-3 times/week
Moderate: exercise 4-5 times/week
Active: daily exercise or intense exercise 3-4 times/week
Very Active: intense exercise 6-7 times/week
Extra Active: very intense exercise daily, or physical job
Desired Weight (kg)
Health Goal
Weight Loss
Weight Gain
Maintenance
Other
Do you take any medications? List the names and dosages.
Your lifestyle?
Active
Sedentary
Food Allergies?
No
Dairy
Eggs
Nuts
Fish
Shellfish
Gluten
Wheat
Legumes
Other
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