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The Dad Bod Redefined The Dad Bod Redefined
  • Home
  • About Me
  • Keto Lifestyle
  • Store
    • Books
    • Food/Supplements
    • Gear
  • FAQ
  • Blog
  • Contact
  • Request a Call

Health History

Home Health History

Men’s Health History

Please write or print clearly. All of your information will remain confidential between you and the Health Coach.


PERSONAL INFORMATION



SOCIAL INFORMATION



HEALTH INFORMATION



MEDICAL INFORMATION



FOOD INFORMATION

What foods did you eat often as a child?


Breakfast

Lunch

Dinner

Snacks

Liquids


What is your food like these days?

Breakfast

Lunch

Dinner

Snacks

Liquids


ADDITIONAL INFORMATION



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