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Updated: 12/23Medical Weight Loss Medical History FormPatient Name: ___DOB: ___/___/___I first became concerned about my weight at age: ___ I started gaining weight because: ___ My weight at age 20
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To fill out Fat Sick and Nearly, follow these steps:
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Start by writing your personal information at the top of the form, including your name, address, and contact details.
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Fill in the details of your current health condition, including any existing medical conditions or illnesses.
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Provide information about your daily routine and lifestyle, including your diet, exercise habits, and work environment.
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Mention any previous weight loss or health programs you have tried in the past.
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Include details about your goals and expectations from the Fat Sick and Nearly program.
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Sign and date the form after completing all the necessary sections.
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Who needs fat sick and nearly?

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Fat Sick and Nearly is beneficial for individuals who:
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- Are obese or overweight and want to improve their health condition.
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- Suffer from chronic illnesses such as diabetes, heart disease, or high blood pressure.
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- Struggle with a sedentary lifestyle and poor dietary habits.
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- Have tried other weight loss or health programs without success.
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- Want to adopt a healthier lifestyle and achieve long-term weight loss.
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Fat Sick and Nearly is a term often associated with health and wellness, particularly relating to the documentary film by Joe Cross which promotes a raw food diet and juicing to improve health.
This term does not refer to a filing requirement; rather, it pertains to a lifestyle or dietary choice. However, if referring to a tax context, one must clarify which specific forms or filings are meant.
Filling out any related documentation would depend on the specific context or form being referred to. For health-related queries, it would typically involve personal health information, dietary habits, and health goals.
The purpose is to raise awareness about health and wellness through dietary changes, primarily focusing on juicing and whole foods to combat obesity and related health issues.
If this refers to a health regimen, information about diet, physical health metrics, and personal wellness goals would be relevant. For tax or legal definitions, it would depend on the specific form requirements.
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