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Revitalise by Jo Beer
Revitalise Newsletter

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Questionnaire Section 1 - Your Body

Given names
Surname
Email (results will be sent here)
Sex
Age (in years)
How did you hear about us?
Weight Kgs      OR     Stone Pounds
Height Metres OR     Feet Inches
Your waist measurement (the mid point between the bottom of your ribs and your hip bone) Cm Inches
Your hip measurement (the widest point 2 to 3 inches above the top of your thighs) Cm Inches