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Be a Soldier
I am Ready
Weight Loss Soldier Form
Present Waist Size
What time of the day do you get up in the morning?
What time of the day do you go to sleep?
How much sleep do you take on a daily basis ?
Do you eat breakfast? If Yes, What kinds of foods you eat for breakfast?
Do you eat lunch? If Yes, what kinds of foods do you eat for lunch?
Do you eat dinner? If Yes, what kinds of foods do you eat for dinner?
Do you eat snacks? If Yes, what kinds of foods do you eat for snacks?
Do you drink Soft drinks such as Pepsi, coke, etc ? If yes, how much in a day?
How much water do you drink daily?
Are you in the habit of exercising?If yes, what kinds of exercises you do?
How often you do these exercises in a week and for how much duration?
When was the last time you exercised your body continuously for 30 minutes (slowly, moderately, high intensity)?
Do you have any specific ailment which prevents you from doing any kinds of exercise? Please elaborate
Do you feel lazy/tired in doing any kind of exercise?
Are you suffering from blood pressure?
When was the last time you got your BP checked from a doctor?
When was the last time you got your Sugar checked?
Do you drink? If yes since when
Do you smoke? If yes since when
Are you a diabetic? If Yes what type
Are you suffering from any other medical/physical ailment? Kindly please elaborate:
Are you taking medications for any ailment you have? Kindly please elaborate:
Are you allergic to any food? Kindly please elaborate:
Why do you want to lose weight?PLEASE SPECIFY A STRONG REASON:
Are you mentally and physically ready to enter "WEIGHT LOSS SOLDIER " program?:
Have you read the weight loss soldier program guidelines?
Are there any obstacles which you think will prevent you to be honestly on this plan? Kindly please elaborate:
2014 Weight Loss Soldier