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Get Bruce Boner Nutritional Assessment Form

__ Weight: _______ Ideal Weight: _______ Blood Type:_______ This questionnaire will help in the study of your present state of health. This information will assist me in choosing an appropriate direction to take in working toward creating your optimal level of health. Please answer each of the following questions: Circle if you eat, drink or use (even occasionally): Alcohol Distilled water Candy Fried foods Luncheon meats Carbonated beverages White flour Margarine Chocolate Potato chips Spring.

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