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Add Clientvrapto2022-06-27T14:37:47+02:00

Blood test received	Blood test received No Yes
Maintenance Request	Maintenance Request No Yes Issued
First Name*
Last Name
Agent*	Please use your log in Code as the Agent reference.
Agent_email*
ID Number
Gender*	Gender Female Male
Age*	Enter 1 if age not available.
Address
City
Province
Country
Postal Code
Phone	Primary contact number
Secondary Number
Start Date	Strict date format 25 February 2013
Email*
Blood Test Date	Strict date format
Starting Weight
Goal Weight
Current Weight
Status*
Program
Cost
Comments
Lead Source
Birthday	Strict date format 31 March 2013
Medical Information (Medication & Allergies
Account paid
One Week	One Week Reminder Set Completed
Two weeks	Two weeks Reminder Set Completed
Four Weeks	Four Weeks Reminder Set Completed
Eight Weeks	Eight Weeks Reminder Set Completed
Twelve Weeks	Twelve Weeks Reminder Set Completed
Sixteen Weeks	Sixteen Weeks Reminder Set Completed
Twenty Weeks	Twenty Weeks Reminder Set Completed
Twenty Four Weeks	Twenty Four Weeks Reminder Set Completed

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