Post on 31-Oct-2020
THIS IS YOUR PERSONAL LIFESTYLE BOOKLET THAT GOES
ALONG WITH YOUR PROFILE EVALUATION RECOMMENDATIONS
KEEP……………..THIS BOOKLET!
REVIEW.………IT EVERY WEEK!
ATTENTION!!!
BRING………IT WITH YOU FOR
EACH…INDIVIDUAL APPOINTMENT!
To help you remember your scheduled evaluations, please record your re-
evaluation dates and time here: You may tape your sessions.
(Be considerate – if you have a personal appointment, please give
coordinator at least 24 hours notice if you need to cancel!)
DATE TIME DATE TIME
Name (Please print)
Occupation
Marital Status: MARRIED DIVORCED SINGLE WIDOWED SEPARATED (Circle)
Others
Weight Age Height
Appendicitis Tonsillitis
Others No
Medications:
Estrogen Birth Control Pills
Do you smoke? # of years you have smoked in the past
# of meals per day Average # of bowel movements per day
Donald Gene: Kraus - Body Life Direct
Street City___________________ ST._________ Zip________ _________________
_State _____ Zip ______________________
Phone ( ) -
Biochemist/Lifestyle Consultant
Client Evaluation Booklet by
Surgeries: Gall Bladder Hysterectomy-complete or partial
NEXT APPOINTMENT DATE:
www.bodylifedirect.com-WEB Site
E-mail-bodylife@mail.com—ph. # 423–552–3631
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