Client Information & Nutrition Coaching Agreement

Name*

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Address*

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Telephone number*

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E-mail*

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Height in feet*

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Weight in Kg*

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How many days a week do you do any form of exercise? i.e. walking, running, gym, cycling, etc*

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Dietary requirement. Please specify if you are Non Veg, Vegetarian, Vegan.*

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Please provide details of any diagnosed medical conditions:*

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How did you hear about Mindful Eating? *

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I confirm that I have read and understood the Disclosure & Nutrition Coaching Disclaimer. I understand that nutrition coaching is educational in nature and is not medical treatment. I consent to Mindful Eating storing and processing my personal information in accordance with the GDPR statement I understand and accept the Programme Cancellation & Refund Policy. *

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