1. Do you normally eat breakfast?
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Yes
Sometimes
Never
2. What did you have for breakfast today?
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1. Nothing ⚠
2. Cereal 🍜
3. Porridge 🍲
4. Yoghurt/Fruit 🍏
5. Toast/Pastries 🍞
6. Tea/Coffee ☕
7. Fried/Cooked 🍳
Other
3. Do you believe the food you eat effects your health?
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Yes
No
4. If you could improve anything, what would it be?
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Energy
Health
Weight
Fitness
5. Would you like help to achieve your better body goals?
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Yes
No
Maybe
Full Name
*
First Name
Last Name
Phone number
*
Mobile number
E-mail
*
Any other info you would like to share:
Current health, goals, reson, time frame etc...
Submit
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