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Basic Info Form

To prepare your plan, we need to know more about you.

Please Complete

What is your Weight &Height ?

Don’t use commas or points.

What is your Goal Weight ?

Don't use comma or points.

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Do you Workout?

Please select

Enter Minutes / Day

What do you eat?

You will be able to specify at the end of the form

  • Beef*

  • Fish *

  • Poultry *

  • Fruits *

  • Diary *

  • Yoghurt *

  • Cheese *

Condition

Please select all that apply and specify in the comment section at the end of this form.

MEDICATION
YES
NO
INSULIN DEPENDENT
YES
NO
MEDICATION
YES
NO
MEDICATION
YES
NO
MEDICATION
YES
NO
TREATMENT
YES
NO
MEDICATION
YES
NO

Condition 2

Please select all that apply and specify in the comment section at the end of this form

TRIMESTER
INFANT AGE
HOW LONG AGO?
HOW LONG AGO?
HOW LONG AGO?

Add Comments

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Congratulations ,

Thank you for choosing Codigo Petaccia. You have submitted your information correctly. You will receive an email notification when your plan is ready in your user account, within three business days. If you haven't received it please check your spam folder.

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