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Name:
   
 
 
Age:
   
 
 
Gender:
   
 
 
Profession:
   
 
 
How long have you been with USANA?
 
less than 1 month
 
1 to 3 months
 
3 months to 1 year
 
more than 1 year

 
 
 
What are your fears, challenges or frustrations?
   
 
 
 
What are your needs, wants, desires or aspirations?
   
 
 
 
What situations are you experiencing that is creating pain and/or urgency?
   
 
 
 
What's your typical average day looks like?
   
 
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