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Hello:
Welcome, please take a short time to complete the questionnaire which will help me learn more about you prior to our session

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Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.

 
 
Contact Information
First Name : 
Last Name : 
Phone : 
Email Address : 
 
 
 
Age
   
 
 
Eye Colour
   
 
 
 
Hair Colour
   
 
 
 
Height (Feet/Inches)
   
 
 
 
Weight (kgs)
   
 
 
 
Shoe Size
   
 
 
 
Bra Cup Size
 
 
 
Waistline