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Additional information (Obesity & Weight Loss)
First name
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Last name
Phone
*
Email
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Do you have an underlying medical condition or are consuming certain medications known to contribute to weight gain (ex: endocrine ailments like thyroid, diabetes), or fluid retention? If yes, please specify which & for how long've you had it?
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Are there any past traumas or unresolved emotional issues that you believe might be influencing your current relationship with food and your body? If yes, please elaborate.
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Are you currently consulting a nutritionist?
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Do you have a regular exercise routine?
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Please state your current weight.
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Please state the weight you hope to arrive at through your efforts, including the support of Pranic Healing energy therapy.
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How would you rate your level of commitment to your wellness journey through energy work on a scale of 0 to 10, where 0 represents no commitment and 10 signifies complete dedication?
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