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Weight Loss Review
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Weight Loss Review form
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Current clothing size
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clothing fit
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Last breakfast
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Last Lunch
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Liquid calories/drinks
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Last Dinner
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Snacks in last 24 hours
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Have portion sizes increased or decreased since your last visit?
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Nutrition Obstacles
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Obstacles other
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Medication use
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Medication use comments
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Medication side effects
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Medication Side Effect comment
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Exercise
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Exercise Duration average per session
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Exercise Frequency per week average
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Exercise obstacles
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Exercise comments
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