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Comments:
Did you watch the video(s)?	Yes     No
How much weight do you want to lose?
Do you need more energy?	Yes     No
How much do you spend on an average meal?
Is there anyone else in your household who wants to lose weight too?	Yes     No
Do you have any other health conditions?
Please contact me about:	Losing weight, improving my health
	I would also like information about sharing these products with others and earning referral fees