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Skype Follow Up Diet Plan Questionnaire Form (Please complete this form to the best of your ability)

Male
Female
Other
Day Shift
Night Shift
Weight loss
Iron deficiency
Cholesterol control
Type 2 Diabetes
High Blood pressure
Bloating
Arthritis
Yes
No
Yes
No
Yes
No
1
2
3
4
5 or more
Cigarettes
Alcohol
E Cigarettes / Vape
No
Yes
No
Yes
No

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